University Withdrawal Request

Please complete this form if you would like to withdraw from the university. The Specific dates referenced in the Statement Section are published in the Official Academic Calendar.
Personal Info
Please Fill Out Each Field
Last Name: First Name:

ID# or Last Four Digits of SSN:



Are you a graduate or undergraduate student?

Please select the appropriate student type.


*Please state your reason for your university withdrawal request.

I understand that by completing this form, I will be withdrawn from all courses and the university. If I wish to attend future terms, I will need to re-apply to the university. There will be NO REFUND from the withdrawal of classes and/or the university after the drop period. Please respond in the box below to acknowledge this.
Please type 'Understood' in the following field.

By clicking Submit I authorize the University to act on the enclosed request.