Student Withdrawal Process

STUDENT WITHDRAWAL PROCESS

Use this form to initiate and document the administrative withdrawal of a student from enrollment. Completion of this form initiates review of academic records, financial obligations, and property clearance. Withdrawal is not effective until processed by the registrar and an authorized school official.

Student Information

Last date of attendance:

Parent / Guardian Information (if applicable)

Withdrawal Details

Effective date of withdrawal:

Reason for withdrawal (check all that apply):

Transfer to another school

Medical / Health reasons

Financial hardship

Family relocation

Disciplinary action / Expulsion

Completed program / Graduated

Other (describe below)

Transcripts and Records

Request official transcript to be sent to new institution listed above

Financial Obligations & Property Clearance

The student or parent/guardian remains responsible for all tuition, fees, and charges incurred through the effective withdrawal date. Transcripts and diploma may be withheld until all financial obligations and property returns are satisfied. Refunds, if any, will be issued according to institutional policy and are subject to prorations and administrative processing.

Return / clearance checklist (administrative confirmation required):

School textbooks returned

Library materials returned / fines cleared

School-issued technology (laptop, charger) returned

Uniforms / equipment returned

Meal account cleared / balance noted

Authorization to charge outstanding balance to card or account: I authorize the institution to charge remaining balances to the account on file or as instructed above.

Academic Record Release & Consent

By signing below the student or parent/guardian authorizes the release of academic records, grades, and disciplinary records to the receiving institution or authorized recipient listed on this form, subject to any limits noted herein. The institution will comply with applicable privacy laws while processing record requests.

I authorize release of records as indicated on this form.

Administrative Use Only

Records released

Hold placed on account

Refund processed / amount noted

Acknowledgment and Certification

I certify that the information provided on this form is true and accurate to the best of my knowledge. I understand that withdrawal may affect financial obligations, academic standing, and eligibility for future enrollment. I acknowledge that the institution may withhold transcripts, diplomas, and records until all obligations and returns are completed. I further authorize institutional personnel to verify information and to communicate with receiving institutions for the purpose of transfer and record release.

I certify that I am the student or the parent/legal guardian authorized to act on behalf of the student.

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