Office of the Registrar
DS 120
Copies: Registrar, Student, Associate Dean for Student Affairs, Director of
Academic Advisement, V.P. for Business Affairs, Financial Aid
Office of the Registrar
8/2018
WITHDRAWAL FROM ALL COURSES
STUDENT NAME: _________________________________________ DATE: ____________
MAJOR: ____________________________________ STUDENT ID NUMBER: ______________________
ANTICIPATED GRAD YEAR: ___________ STUDENT ATHLETE: □ YES □ NO
mm/yyyy
RESIDENT □ COMMUTER □ VETERAN: □ YES □ NO
REASON FOR WITHDRAWAL: _______________________________________________________________________
REQUIRED SIGNATURES
**If you are a STUDENT ATHLETE this form will not be processed unless signed by the Athletics Director/Director of Compliance**
_______________________________________ ____________
Signature of Advisor Date
_______________________________________ ____________
Signature of Student Date
_______________________________________ ____________
Signature of HEOP Advisor Date
(If applicable)
_______________________________________ ____________
Signature of Financial Aid Office Date
_______________________________________
Signature of Athletics Director or
Director of Compliance
(If applicable)
_______________________________________ ____________
Signature of Office of Date
Academic Advisement
1. If a student withdraws from all current semester courses and intends to return the following semester, no
additional forms need to be completed
2. If a student withdraws from all current semester courses and plans to return after a semester or a year’s leave, a
Leave of Absence form should also be completed
3. If a student withdraws from all current semester courses and plans to withdraw from the College, a Notice of
Intent to Withdraw form should also be completed
LAST DATE FOR AUTHORIZED WITHDRAWAL:
APPROXIMATELY TWO WEEKS FOLLOWING THE DATE OF SUBMISSION OF MID-SEMESTER
DEFICIENCIES – CONSULTTHE ACADEMIC CALENDAR OFR THE EXACT DATE
FOR USE OF THE OFFICE OF THE REGISTRAR/REGISTRATION
Action Approved on: ____________
By: ___________________________
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