SVSTI Change of Status

SVSTI
SVSTI Student Status Change Form
Student's Full Legal Name*
Program Enrolled In. *
Student's Full Mailing Address (w/City & Zip) *
Phone*
Status

Cancel (Before starting SPD or 14th day ST)Withdraw (if you started the Program)Drop (Failed)Leave of Absence (only if pre-approved)Move Start Date (only allowed once)Repeat CourseRe-Entry
New Start Date

MonthDayYear
Date
Re-Entry (only if pre-approved)

MonthDayYear
Date
Reason (required)*
Student Signature*

Clear
Today's Date*

MonthDayYear
Date
Comments
*A non-refundable cancellation fee of $100 for ANY change will apply in accordance with SVSTI's Cancellation Policy.
Students may only be eligible to change their Program start date one time.*
Student Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty: