Withdrawal Form

Use this form to withdraw from the university. If you want to drop a single class, please contact your academic advisor.

Are you the student withdrawing? *

Are you the student withdrawing? Yes No
Name of staff person requesting student withdrawal Name of staff person requesting student withdrawal * First Last
Student Information
Student Name Student Name * First Last
Student ID# *

Your 774 number, NOT your social security number.
Student Type *

Student Type Undergraduate Student Graduate Student Provisional Licensure Program
What is your program? *

What is your program? MAHP (Health Promotion) MAT (Teaching) MED (Education) MSW (Social Work) Certificate Programs
Preferred Email: *
Phone Phone * - ### - ### ####
Is this your first term at Concord? *

Is this your first term at Concord? Yes No
Please Check All That Apply *

Please Check All That Apply Student Support Services (SSS) participant Bonner Scholar International Student Residential Student (on-campus housing) Have a campus mail box Have a job on campus (including Graduate Assistantship) RBA student Veteran/receive Veteran's benefits Disability Services None of the above
What address should we use for mail forwarding? What address should we use for mail forwarding?
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
You must leave the residence hall within 48 hours, properly check out, and return your key.
Did you receive check change, grants, scholarships, loans, or third-party funding? *

Did you receive check change, grants, scholarships, loans, or third-party funding? Yes No
You may have a balance on your account. If you have a balance, you will receive a written notice from the Business Office.
Do you have student loans? *

Do you have student loans? Yes No
You are required to participate in exit counseling. Please complete the following form: https://studentaid.gov/app/counselingInstructions.action?counselingType=exit. If you need help call the Financial Aid Office (304-384-6069).

***If you are withdrawing from a summer term but plan to return in the Fall you DO NOT need to complete exit counseling.***
Withdrawal Information
From which term(s) are you withdrawing? *

From which term(s) are you withdrawing? Spring 2021 Summer I 2021 Summer II 2021 Fall 2021
From which term(s) are you withdrawing?

From which term(s) are you withdrawing? Fall 2020
Reason for Withdrawal *

Reason for Withdrawal Academics Financial Medical Personal Social Atmosphere/Environment Transfer
Please explain the reason for your withdrawal. *
Why are you transferring? *

Why are you transferring? Program not offered at Concord Had planned to transfer originally Other Other
Where will you be attending school in the future? *
What is your major at your new institution? *
Do you plan on returning to Concord University in the future? *

Do you plan on returning to Concord University in the future? Yes No Unsure
When do you plan to return? *

When do you plan to return? Summer 2021 Fall 2021 Spring 2022
Have you attended any classes during the term from which you wish to withdraw? *

Have you attended any classes during the term from which you wish to withdraw? Yes No
Your CU Experience
How satisfied were you with your academic experience at Concord? *

How satisfied were you with your academic experience at Concord? Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied
Please explain why you were dissatisfied with your academic experience: *
How satisfied were you with your social experience at Concord? *

How satisfied were you with your social experience at Concord? Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied
Please explain why you were dissatisfied with your social experience: *
How satisfied were you with the support services offered at Concord (e.g., advising, counseling services, career services, financial aid, etc.)? *

How satisfied were you with the support services offered at Concord (e.g., advising, counseling services, career services, financial aid, etc.)? Very satisfied Somewhat satisfied Somewhat dissatisfied Very dissatisfied
Please explain why you were dissatisfied with the support services offered at Concord: *
Please comment about your experience at CU. Is there something we can do to improve the CU experience for you and other students? *
Comments about withdrawal:
Please refer to the Academic Catalog for policies regarding withdrawal from the university, refunds, etc.
*

I have read and understand the withdrawal policies for Concord University.
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Withdrawal Form

Withdrawal Form

Student Information

You must leave the residence hall within 48 hours, properly check out, and return your key.

You may have a balance on your account. If you have a balance, you will receive a written notice from the Business Office.

Withdrawal Information

Your CU Experience

Please refer to the Academic Catalog for policies regarding withdrawal from the university, refunds, etc.