Official Withdrawal Form

OFFICIAL WITHDRAWAL FORM

(Official Withdrawal from ALL Classes)
YEAR*
SEMESTER*

FallSummerSpring
Student Name (Last, First, MI)*
Date of Birth*

MonthDayYear
Date
Student ID Number*
Permanent Address*
Permanent Phone
Mobile*
Email Address*
example@example.com
Official withdrawals from the University of Holy Cross will only be processed using this official form. Please indicate the primary reason for withdrawal and include details in the space provided.
Official withdrawals from the University of Holy Cross will only be processed using this form. Please indicate the primary reason for withdrawal and include details in the space provided.*
Withdrawal Details*
It is the responsibility of the student to contact the appropriate offices (if applicable) below to ensure proper withdrawal. Please initial to verify that you have consulted each office that is relevant to your enrollment.
Academic Advisor*

Clear
Financial Aid (FA recipients only)

Clear
Bursar*

Clear
VA Certifying Official (VA Benefits only)

Clear
FINANCIAL AID RECIPIENTS - Are you receiving any form of financial aid (grants, loans, work study)?*

YESNO
*You will be required to repay any unearned portion of the financial aid you have received. If you are withdrawing in person, you must speak with a Financial Aid and Scholarships counselor to discuss your financial aid liabilities (if any) and your payment options. If you are not withdrawing in person, you are responsible for reading all notifications (email and/or letters) sent to you regarding your financial aid liabilities (if any) and your payment options.
I understand that I have officially withdrawn from the current semester only. I acknowledge that if I am withdrawing from courses outside of the registration period, I will be financially responsible for tuition and fees. I assume full responsibility and release the college administration from any and all liability as a result of changes made to my schedule.
Signature*

Clear
DATE*

MonthDayYear
Date
Should be Empty:

OFFICIAL WITHDRAWAL FORM