University Withdrawal Form
Associate, Bachelor, Graduate, and Doctoral Programs

University withdrawals submitted without the student (unless administrative or academic suspension/dismissal withdrawal)andstaff/advisor signature will not be accepted or processed. Students who do not officially withdraw from Judson University by completing and submitting this form will be held responsible for the full payment of tuition and fees, and grades of Administrative Withdraw Fail (AWF) will be assigned for all unfinished courses. Questions regarding billing and financial aid should be directed to those respective offices.

Student Name (please print): ______

ID#:______Program:  AA  BA  GR  DOCT Major: ______

Please feel free to use the follow area to share comments/concerns regarding your Judson experience (your honesty and feedback is important to us-please use the back of this form if additional space is needed):

______

______

Please place a check mark next to the option that appropriately identifies with your situation:

I _____receive____ do not receive financial aid benefits.

I _____receive _____do not receive educational benefits from the Veterans Administration.

I _____plan _____do not plan to enroll again at Judson University in the future.

By signing below, I am stating that I am withdrawing from Judson University at this time. I understand I am responsible for the student balance that remains after the withdrawal and my financial aid may be affected.I understand that tuition, fees, etc. and grades will be assigned according to the withdrawal calendar. I understand that if I do plan to enroll again, I must contact theEnrollment Office. In addition, due to my withdrawal, I understand that I may be required to complete additional requirements. Please note: An email will be sent within 3 business days to your Judson email account to confirm the withdrawal from your courses is complete.
Student Signature______Date______

Advisor/Judson Staff to complete areas below:
DOD: ______Advisor/Judson Staff Signature______Date______
Mark Reason for Withdrawal:

Administrative Withdrawal (no attend/response)

Academic (major, program, teaching, technology)

Academic Suspension/Dismissal

Family Emergency (death, divorce, care for family)

Financial (Aging balance, SAP, inability to afford, change in financial aid, tuition reimbursement issues)

Job Emergency (job transfer, loss of job, increased responsibility)

Military, Church Missions, Jury Duty

Other (please specify): ______

A Responsibility: _____ Drop _____ Trans _____ EM student _____Scan to DOR _____Original to student file
DOR Responsibility: _____ Reason Code____ Ret Entry ____ PE____Excel ____ EM to Non Group____Google Doc