Texas Woman’s University
TERM WITHDRAWAL FORM
Use this form only for removal from ALL COURSES within a term
YEAR: _________________
SEMESTER: ____________
Part 1: Completed by Student
Date Initiated: __________________ ID#: __________________ Phone number: ____________________________________
Last name: ____________________________ First name: _____________________________ Middle: ___________________
Local Address or Residence Hall Room: _____________________________________________________________________
Permanent Mailing Address: _______________________________________________________________________________
Street City State Zip
Are you:
International Student ________ If receiving a refund: apply to a future semester (specify term)
A Financial Aid recipient ________ apply to credit card used in online payment
A Student Athlete ________ (mandatory if credit card used for online payment)
Utilizing VA benets ________
Reason for Withdrawal: ___________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
I hereby request that I be withdrawn from Texas Woman’s University for the current semester/term subject to all regulations pertinent
to withdrawal and refunds and afrm that all above information is correct. I understand that subsequent registration or re-admission
must be in accordance with the University’s regulations in effect at the time. I understand that all my nancial obligations to the
University must be paid before I may register again or receive copies of my academic records. If I am eligible for any refund, I am
aware that it will be computed as of the effective date of this action and may be reduced by any debt I currently owe the University
or my failure to complete the withdrawal process. I understand that I am responsible for obtaining the instructors’ signatures, and that
the withdrawal grades must be assigned by the instructors at that time. By my signature below, I acknowledge that I have read and
fully understand the information on the Withdrawal Form.
Student’s Signature: ____________________________________________________ Date: ___________________________
Form must be turned in to the Ofce of Student Life.
For questions, please contact Ofce of Student Life. Phone: 940-898-3615, Fax: 940-898-3629
Part 2: After academic penalty date for term, this section must be completed. See online academic calendar for census dates.
REQUIRED: Instructor’s signature & assigned grade of W or WF after no penalty period. Failure to obtain both will result in an automatic WF.
Part 3: Completed by the Vice President of Student Life
The student listed above, enrolled in the College of ________________________has been withdrawn from
Texas Woman’s University. Ofcial Withdrawal Date: ______________________Semester: ____________ 20 ________ .
Comments: _____________________________________________________________________________________________
________________________________________________________________________________________________________
______________________________________________ ___________________________________________
Vice President for Student Life Date
DEPT COURSE DATEDESCRIPTION INSTRUCTOR SIGNATURESEC W WF
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