Tennessee Tech | Office of the Registrar | Jere Whitson Building, Room 221 | 931.372.3317 | tntech.edu/records/
Office of the Registrar
TENNESSEE TECH
Student Name: ________________________________________________________ T#: ______________________
(Last) (First) (MI)
Term/Year: ___________________ Email: ______________________________ Phone: ___________________
Please check any of the following that apply to you:
Current Student (attended classes this term) Resident of University Housing Student Athlete
International Student HOPE/Financial Aid Recipient Veteran
Please initial each of the following:
___ I understand that I may not enroll or receive a diploma, transcript of my record, or grade report until all matured debts or obligations
to the University, or any phase of its program, have been cleared.
___ I understand that by withdrawing from the University, I am withdrawing from all of my classes. If we are in the “W” grading period
(usually the third week of classes), I will receive a “W” in all of the classes for which I am currently enrolled. If I withdraw before “W”
grading begins, I will not receive a grade in any of my classes. Processing of this withdrawal may take up to three (3) business
days. This withdrawal will be confirmed by an email from the Registrar’s Office sent to my tntech.edu account.
___ If you are receiving any type of financial aid, withdrawing from the University may impact your eligibility. I acknowledge
that I may be required by federal law to repay some or all of any financial aid I have received to attend TTU.
___ I acknowledge I will not receive a refund if this request is submitted beyond a refund period. My withdrawal does not cancel fees
and charges already incurred. View published refund deadlines at www.tntech.edu/calendar.
___ I understand if I live on campus I will check out of my housing within 48 hours of the withdrawal. I agree to directly contact my
Residential Life staff when I withdraw for more information.
___ If I am an International Student, or if I am receiving any type of Veteran Benefits, I acknowledge I have contacted the appropriate
International Education Office personnel (for International students) or my campus VA personnel (if receiving VA benefits) to
discuss my withdrawal and any potential impact on my educational benefits.
Student Signature: _____________________________________________________ Date: _____________________
Registrar Signature: ____________________________________________________ Date: _____________________
OFFICE USE ONLY: Account Balance (AP) Account Balance (LA)
Reason for Withdrawal (please check any that apply to you):
Difficulty Adjusting Program of Study Academic Progress
Military Service Financial Issues Course Availability
Difficult Living Arrangements Family Responsibilities Job/Work Schedule
Medical Issues | Family Illness/Death Intend to Transfer to Another College/University
