Petition for Withdrawal

Name                                                                           ___  Student ID:_____________Date:________

I wish to withdraw from my enrollment in the                                                 degree program, effective                                            (date).                                        

I desire to withdraw for the following reason(s):                                                                                              

My plan for the current quarter's classes is as follows:                                                                         

I have discussed this matter with my advisor, and the Dean of the Community.

My forwarding address will be:                                                                                                                 

I shall follow through in securing the signatures of those listed, and then will return this form to the Registrar for transmittal and action by the Dean prior to my departure from campus.

Name:                                                                                       Date:                                                    

            (Please print)

            (Signature)

(over)

Petition for Withdrawal

Student's Name:                                                              Date:                                                             

The above named student has petitioned for withdrawal. Your signature below will indicate that the records warrant such action, that outstanding debts have been paid or payment negotiated, and that in your opinion, the reasons stated are acceptable.

N.B.     International students must see the Director of Graduate Studies.

            Students with guaranteed loans (GSL) must see the Dean of Community.

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                                                Signature of Approval                                                          Date

Advisor                                                                                                                                                

Financial Aid Officer                                                                                                                         

Dean of the Community                                                                                                                          

Director of degree Program                                                                                                                          

Director of Field Education                                                                                                                      

Director of Graduate Studies                                                                                                                     

Director of Internat'l Student Affairs _____________________________ _________

Library                                                                                                                                                 

Housing Director                                                                                                                                    

Vice President for Finance                                                                                                              

Registrar                                                                                                                                               

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Action by Dean:           Approved: _____    Denied: _____

Comments:                                                                                                                                         

Signature of Dean:                                                                                                                               

                                                                                                                                    Date

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Copies to:                                                                                               by                     on                   

Last Revised 3/20/06