JM University Resignation Form
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date
*
-
Month
-
Day
Year
Date
Term (Check ONE term)
*
Fall
Spring
Campus (Check ONE)
*
JMU Crowley
JMCC-Pace
JMCC-Winter Park
Year
*
Major
*
Is this your first term of enrollment at John Melvin University?
*
Yes
No
Reason for resignation/withdrawal:
*
Financial
Personal
Transfer to another College/University
Military (copy of activation papers needed)
Suspension (academic, honor system, student conduct)
Academic/Medical Relief (requires letter from Doctor)
Other
If Other was selected, please specify why:
Last Day of Attendance:
*
-
Month
-
Day
Year
Date
I hereby resign/withdraw my current enrollment at John Melvin University for the term and year indicated above. I understand that this does not relieve me of any financial obligation to the university.
*
Date
*
-
Month
-
Day
Year
Date
Withdrawals and resignations that are required to receive Academic Dean's approval must have an effective date. The Office of the University Registrar will not process requests after the first day of classes without one. The effective date should be based on the student's last date of actual attendance in a course and should not be prior to that date. Please document the effective date and list any comments.
Academic Dean Signature
Date
-
Month
-
Day
Year
Date
Registrar Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: