Withdrawal Form
Name
First Name
Last Name
Student ID
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Status
Dual Enrollment
Advisor Name
First Name
Last Name
High School
Please Select
Edna Karr
Dr. MLK Jr High School
McDonogh 35
Sophie B Wright
St. Augustine
New Orleans Sci high
John Ehret
Haynes Academy
McMain High
International High
Rooted School
The NET
Abramson
West Jeff
Peabody
Sarah T Reed
Upward Bound
Thomas Jefferson
Warren Easton
St. Mary's Academy
Haynes Academy
Carver
Cohen
Booker T Washington
Livingston
Frederick Douglass
John F Kennedy
Active Semester
Fall
Spring
COURSE WITHDRAWAL REQUEST
Configurable list
*
What is the reason for your withdrawal?
Have you already talked to your counselor or advisor?
Yes
No
Reminders
All of the student's information can be found in the portal. i.e. student ID number and email address if using sus email
Withdrawing during the first week in school will be eligible for refund.
If the student withdraws after the first week, fees will not be refunded.
This is only a request! It will be submitted to your advisor/counselor/administrator at your school for final approval.
Signature
Date Signed
-
Month
-
Day
Year
Date
Registrar's Office Use Only
Withdrawn By
Withdrawal Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: