JM University Resignation Form

JM University Resignation Form
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Date*

MonthDayYear
Date
Term (Check ONE term)*

FallSpring
Year*
Major*
Is this your first term of enrollment at John Melvin University?*

YesNo
Reason for resignation/withdrawal:*

FinancialPersonalTransfer to another College/UniversityMilitary (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:*

MonthDayYear
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*

MonthDayYear
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

MonthDayYear
Date
Registrar Signature
Date

MonthDayYear
Date
Should be Empty: