Undergraduate Student Request Form for Withdrawal /Deferral from Maynooth University

  1. Read, Complete and sign thisStudent Request Form.
  2. Contact the Fees & Grants Office for Current Fee Status and expected Fee liability if returning.
  3. Contact the Academic Advisory Office(Tel. 01-7083368) for an “Exit” interview.
  4. Obtain signature from the Academic Advisor on completion of the Exit Interview.
  5. Submit this Student Request Form to the Student Records Office, Humanity House together with yourStudentID card to officially de-register from your course.
  6. Note:Registration will be cancelled as of the date of receipt of the completed Student Request Form in the Student Records Office up to the end of the Academic Year.

Name:Student No.
Current Course of Study:
  1. Please indicate your reason for leaving the course:
Medical Reasons……………………………...... Did not Like the Course /Subjects………………...
Financial Reasons……………………………....Found the Course Difficult……………………...... 
Personal Reasons……………………………….Changing to Professional Qualification Course...... 
Family Reasons………………………………....Moving to a different University………….….…...
Commuting Problem……………………………Year Out to Travel……………………….…….….
Accommodation Problems……………………...Other Reason……………………………………...
  1. Do you intend to return to NUI Maynooth in the next Academic Year? Yes No 
If “Yes”, do you intend to return to the same course? Yes No 

3.Student I.D. Card Returned Yes No 

Student Signature:Date:

Confirmation of Attendance with the Fees & Grants Office:

Current Fees Status: Fees in Order □Outstanding Balance □

Medical Certs(where appropriate)Submitted Yes □ No □

Expected Fee Liability upon return to NUIM (where appropriate)

Signature:Date:

Comment:

Confirmation of Attendance with the Academic Advisor:

Signature:Date:

Comment:

Note for First Year Students returning to the Same Course:

  • Withdrawing before the 31st of October and returning to the same course the following year the student must re-apply to the CAO and put their current course as their First Preference on the CAO form to guarantee their place on the course.
  • Withdrawing after the 31st of October and returning to the same course the following year their place on the course is held internally. Donot re-apply to the CAO.

Note for First Year Students returning to pursue a Different Course:

  • Withdrawing at any part of the year and returning to pursue a different course the following year the student must re-apply to the CAO. Do not put the current course in the CAO preference.

Note for Continuing Students returning to the Same Course:

  • Withdrawing at any part of the year and returning to the same course the following year, the place on the coursefor all non-first years is held internally.

For Student Records Office Internal Use:

Date qualification De-Registered from Student Records System:

Application Record created for Deferred Students: Yes □No □

Certificate Seen Indicator Updated: Yes □No □

Copy of Completed Form given to Student upon De-Registration: Yes □No □

Signature: Date: