Fillable WITHDRAWAL REQUEST A student who wishes to withdraw

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WITHDRAWAL REQUEST A student who wishes to withdraw

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June 2018, OOTR
WITHDRAWAL REQUEST
A student who wishes to withdraw from TCSPP must complete and submit this form. A student is strongly advised to speak with the academic department, Student Accounts,
and Financial Aid prior to submitting this form. A student is responsible for adjustments made to the student account balance or financial aid eligibility as a result of withdrawal.
STUDENT INSTRUCTIONS:
1. Complete this form in its entirety, specify the reason for withdrawal
2. Submit the signed form to your Student Support Counselor.
CHICAGO/TCSPP@XULA
800.595.6938 (phone)
312.488.6301 (fax)
Chistudentsupport@thechicagoschool.edu
ONLINE
800.595.6938 (phone)
312.254.1442 (fax)
Onlinestudentsupport@thechicagoschool.edu
DALLAS
800.595.6938 (phone)
214.575.9090 (fax)
dalstudentsupport@thechicagoschool.edu
SOUTHERN CALIFORNIA
800.595.6938 (phone)
213.615.7286 (fax)
Castudentsupport@thechicagoschool.edu
WASHINGTON, D.C.
800.595.6938 (phone)
202.706.5199 (fax)
Dcstudentsupport@thechicagoschool.edu
STUDENT NAME:
STUDENT ID:
TCSPP E-MAIL:
PHONE:
CELL PHONE:
OTHER E-MAIL:
DEGREE LEVEL:
LOCATION:
TERM/SEMESTER & YEAR:
PROGRAM:
TYPE OF WITHDRAWAL
OFFICIAL UNOFFICIAL(ADMINISTRATIVE)
TEMPORARY (Department Chair approval required) due to:
Course Unavailability Significant Life Change Expected Return (Term/Semester and Year): (cannot exceed 2 terms/1 semester)
CURRENT ENROLLMENT (check one) STATUS (check all that apply)
I plan to complete the courses I am enrolled in before withdrawal OR International Student TCSPP Student Employee (FWS)
I plan to immediately withdraw from my current courses Active Military/Veteran
I wish to withdraw from school. My last term/semester of enrollment will be:
Fall Spring Summer Year: 20 Session I Session II
REASON FOR WITHDRAWAL: Financial Health/Medical Personal/Family Work Schedule Withdrawal Non Start
Called to Active Duty (supporting documentation may be required) Transfer to Another School (Name of School):
Other (Please Specify):
Please read and sign below:
“I understand that I am responsible for returning all library books and other borrowed materials and for fulfilling all financial obligations to the institution as outlined in the
Student Handbook. I understand that withdrawing from the institution means that I will no longer have access to electronic resources, including my school email account.”
STUDENT SIGNATURE:
DATE:
FOR OFFICE USE ONLY
I. DEPARTMENT CHAIR: (Approval Required for Temporary Withdrawal Only)
Approved Denied Comment: Signature: Date:
II. DSO NOTIFICATION (International Students Only)
Comment: Signature: Date:
III. OFFICE OF THE REGISTRAR: Official Withdrawal Unofficial (Administrative) Withdrawal-indicate reason in comment section
Temporary Withdrawal Comment:
Is the student on Hold ARPP-PRI? Yes No Signature: Date:
IV. FINANCIAL AID
Comment: Signature: Date:
V. STUDENT ACCOUNTS
Balance Due No Yes Amount: Signature: Date:
FOR USE BY THE OFFICE OF THE REGISTRAR
DOD: LDA: NSLDS WDRWL:
Processed by:
Date:
Course(s) Unregistered:
Yes No
Grade Assigned:
W N/A WF/NC/NP
Week: Refund %:
Notifications: IT Facilities ISA Library OPT HR (TCSPP Student Employees Only)
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WITHDRAWAL REQUEST A student who wishes to withdraw

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Completed 22 July 2020

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