Fillable WITHDRAWAL FORM COURSE OR UNIVERSITY Summerville Campus Rains (Augusta University)

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WITHDRAWAL FORM COURSE OR UNIVERSITY Summerville Campus Rains (Augusta University)

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  • 36 check-boxes
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For your convenience, we accept forms via email at records@augusta.edu
. We encourage you to use an electronic signature to help expedite
the process. Instructions for signing documents electronically, can be found at https://www.augusta.edu/esignature/.
Adding, Dropping, & Withdrawing Policy: https://www.augusta.edu/compliance/policyinfo/policy/adding-dropping-withdrawing-from-courses-undergraduate-students.pdf
The Withdrawal Form is used to withdraw from a class or all classes at Augusta University. After the schedule adjustment period has ended,
the official withdrawal date is the date the student notifies the Registrar's Office of their intent to withdraw by submitting the completed
withdrawal form with all required signatures. Refunds are only processed for full withdrawals from all classes.
After the add/drop period has ended, a student may withdraw from a course without penalty up to the midterm date set forth in the Academic
Calendar. For Undergraduates, only five (5) withdrawals are permitted at Augusta University (effective Fall 2013). The sixth and subsequent
Ws will be computed as Fs in the GPA.
Following the withdrawal deadline, a student who withdraws will receive a grade of WF (Withdrew Failing) for enrolled courses, except in
extraordinary situations approved by the Department Chair or Dean or in cases of medical, hardship, or military withdrawal. WF grades will be
treated as F grades for grade point calculations. When the situation falls under the Medical or Hardship withdrawal guidelines, the student
must contact the Office of the Dean of Students (706-737-1411, Bellevue Hall) prior to the end of the semester to request such a withdrawal.
Note: As a Title IV recipient, in accordance with Federal regulations, all or a portion of a student's loans or grants may be removed from their
account. In the event funds are removed, the student agrees to pay any outstanding charges that result from this federal calculation.
According to Augusta University policy, institutional scholarships and grants may be removed thus creating additional charges for which the
student is responsible. Furthermore, if there are charges which have been incurred that have not yet posted to the student account, the
student understands that it is their responsibility to follow up with the Office of Student Financial Aid regarding financial aid and furthermore
that they must pay any balance in full upon withdrawing from Augusta University. Payments may be made through POUNCE or in the Business
Office.
Note: For those students in The Graduate School programs (lockstep and non-lockstep) and for those students in lockstep programs outside of
The Graduate School, if you are withdrawing from all classes, please note that you will be withdrawing from the program and university. If you
will be returning to the program/university, a Reactivation Form must be submitted. If you remain withdrawn from the program/university for
3 consecutive semesters, you must reapply to the program/university.
Course Withdrawal Checklist
1. Complete Withdrawal Form Sections 1, 2, and 4.
2. Notify Military & Veterans Services and/or Housing &
Residence Life, if needed.
3. Contact Financial Aid to inquire how the withdrawal may impact
your account.
4. Submit the completed form to the Registrar’s Office via email
at records@augusta.edu
.
5. Pay any remaining tuition, fees, and other charges on your
student account in POUNCE.
6. Confirm withdrawal is listed appropriately on your student
record in POUNCE.
Complete University Withdrawal Checklist
1. Complete Withdrawal Form Sections 1, 2, 3, and 4.
2. Notify Military & Veterans Services and/or Housing &
Residence Life, if needed.
3. Contact Financial Aid to inquire how the withdrawal may impact
your account.
4. Submit the completed form to the Registrar’s Office via email
at records@augusta.edu
.
5. Return any books, equipment, or materials on loan from
Augusta University.
6. Review your account and update your personal information
(phone, address, bank account, etc.) in POUNCE.
7. Pay any remaining tuition, fees, and other charges on your
student account in POUNCE.
8. Confirm withdrawal is listed appropriately on your student
record in POUNCE.
9. Order an official transcript, if needed.
University Contact Information:
Academic Advisement academicadvisement@augusta.edu 706-731-7979 University Hall - 262
Athletics athletics@augusta.edu 706-737-1626 Christenberry Fieldhouse
Business Office business_office@augusta.edu 706-737-1767 Payne Hall – First Floor
Financial Aid osfa@augusta.edu 706-737-1524 Fanning Hall – First Floor
Housing & Residence Life residencelife@augusta.edu 706-729-2300 Oak Hall
International & Postdoctoral Services Office ipso@augusta.edu 706-721-0670 Kelly Admin Building - 2013
Registrar’s Office records@augusta.edu 706-446-1430 Rains Hall
Student Health Services studenthealth@augusta.edu 706-721-3448 Pavilion II - 1040
Office of the Registrar
Summerville Campus
Rains Hall
(706) 446-1430
records@augusta.edu
WITHDRAWAL FORM
COURSE OR UNIVERSITY
Page 2 of 2
Course Number
& Section
(ENGL 1101 A)
(Required for All Withdrawals)
CRN
(23456)
(Required for
All
Withdrawals)
Instructor
Printed Name
(Required for All
Withdrawals)
(Required for All
Withdrawals)
W or
WF
(Required
for All
Withdrawals)
Last Date of
Attendance
(Required for All
Withdrawals)
Program Director/
Department Chair/Dean
Printed Name
(Required Only for “W” After Midterm)
Program Director/
Department Chair/Dean*
Signature
(Required Only for “W” After Midterm)
Note: The last date of attendance is the last date the student participated in the course. This date is required for all withdrawals.
PART 1: STUDENT INFORMATION
First Name: ___________________
Middle Initial: _____
Last Name: _________________________
Student ID: _________________
Mailing Address
(Street, City, State, Zip)
: ____________________________________________________________________________
Phone Number: ______________________
Cell Home
Non-AU Email: _____________________________________________
Degree: ______________________
Major:______________________________
Student Athlete: No Yes
Graduation Application on File? No Yes
Note: Withdrawal from a required course for graduation will impact your eligibility to graduate and participate in commencement.
PART 2: REQUEST INFORMATION – COURSE WITHDRAWAL
Term of Withdrawal: Fall Spring Summer 20
Are you withdrawing from all courses? No Yes – Complete Part 3: Request Information – Complete University Withdrawal
PART 3: REQUEST INFORMATION – COMPLETE UNIVERSITY WITHDRAWAL
I would like to withdraw completely from AU. I understand my withdrawal does not release me from any financial obligations I may have to AU and that I
must return all University property in my possession (equipment, books, educational media, keys, ID cards, etc.) to the appropriate campus office.
If eligible, do you plan to return to AU?
No Yes
If yes, when do you plan to return?
Fall Spring Summer 20
Reason for Withdrawal: Employment Family Health Military Personal Transfer – Institution: ___________________
Academic (explain)
___________________________________
___________________________________
___________________________________
Financial (explain)
___________________________________
___________________________________
___________________________________
Other (explain)
___________________________________
___________________________________
___________________________________
PART 4: REQUIRED SIGNATURES
Student Printed Name: _________________________________
Student Signature: ________________________________
Date: ___________
*I understand that I may be considered for a refund only if I completely withdraw from the University.
Advisor Printed Name: __________________________________
Advisor Signature: _________________________________
Date: ___________
*Required for Undergraduate Degree-Seeking Students
Athletic Director Printed Name: __________________________
Athletic Director Signature: _________________________
Date: ___________
*Required for Student Athletes
Dean/Associate Dean Printed Name: _____________________
Dean/Associate Dean Signature: _____________________
Date: ___________
*Required for Student in The College of Allied Health Sciences, College of Nursing, Dental College of Georgia, and Medical College of Georgia
TGS USE ONLY -
Required for Programs within The Graduate School
TGS Dean/Vice Dean Printed Name: ______________________
TGS Dean/Vice Dean Signature: _____________________
Date: ___________
Eligible to Return to Program if Reenrolled By:
Fall Spring Summer 20
*Must Complete Reactivation Form
Eligible to Return to TGS if Reenrolled By:
Fall Spring Summer 20
*Must complete Reactivation Form
Eligible to Return to Augusta University
Not Eligible to Return to Program – Add IP Hold
*Must Reapply via Academic Admissions
Not Eligible to Return to TGS – Add IE Hold
*Must Reapply via Academic Admissions
Not Eligible to Return to University – Add IR Hold
Comments:
Recommended for Dismissal? No Yes
PART 5: REGISTRAR USE ONLY
Date Received: ____________ Received By: _____________ Processed By: _____________ Date Processed:_____________ Official Date of Withdrawal:
_____________
WITHDRAWAL FORM - COURSE OR UNIVERSITY
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WITHDRAWAL FORM COURSE OR UNIVERSITY Summerville Campus Rains (Augusta University)

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Completed 26 August 2021

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