OfficeofRegistrationRecords

Phone:(812)237-2020Fax:(812)237-8039

RetroactiveWithdrawalForm

Submissionofthisforminitiates the request for a retroactivewithdraw. This request isonlyactive forthesemesterindicatedanddoesnotimpactoverallacademicstandingwiththeUniversity. Aseparateformisrequiredforeachsemesterfromwhichthestudentwishestowithdraw. For requests of semesters over one year, withdrawals have to be reviewed by Academic Affairs prior to approval.Pleasecompleteallrequestedinformationandreturnthisformeitherbymailto:OfficeofRegistrationRecords,ParsonsHall,Room009,IndianaStateUniversity,TerreHaute,IN47809;byfaxto(812)237-8039;orbyemailto:.

PersonalInformation

LastNameFirstNameMIISUStudentID#(991-XXX-XXX)

EmailAddressPhoneNumber

WithdrawalInformation

WithdrawalTerm(ChooseONE)

FallSpringSummerISummerII

Year

Retroactive Withdraw Reason

(Only reasons listed below are applicable to non-current semester withdrawals)

Note:Withdrawal requestsfrom international studentsand studentathleteswill berouted throughappropriate officesforapprovalpriortoprocessing.

Terms and Conditions

Pleasereadeachitemcarefullyandsignthatyouunderstandandacceptthetermsandconditions:

SubmissionofthisformauthorizesanexchangeofmyrelevantpersonalinformationonmybehalfbetweenpertinentUniversityofficesinordertocompletethewithdrawalprocess.

ItismyresponsibilitytoconsultwiththeOfficeofStudentFinancialAidtounderstandexactlyhowthiswithdrawalwillaffectmyfinancialaideligibilitynowandintothefuture,aswellasmyoverallfinancialresponsibilitytoIndianaStateUniversity.

Basedontheeffectivedateofmywithdrawal,myacademicfeeswillbeadjustedaccordingtoISU'spublishedrefundpolicyasapprovedbytheBoardofTrustees.TheamountofmyrefundmaybereducedbyfinancialobligationsatISUortoothersource(s)offinancialaid.MyaccountbalancewillbeviewablethroughtheMyISUPortal.

Ihavebeenprovidedwiththe"WithdrawalImportantInformation"document.

Iunderstandthat if approved,Iwill be withdrawnfromall ofmyclasses fortherequestedterminwhichI was enrolled atISU:

StudentSignatureDate

OFFICE USE ONLY

DateWithdrawalInitiated

ReceivedByDateProcessedByDate

IndianaStateUniversityWithdrawalImportantInformation

AseparateSemesterWithdrawalAuthorizationFormmustbesubmittedforeachtermfromwhichyouwishtowithdraw.SubmissionofthatformwithdrawsyouonlyfromthesemesterindicatedanddoesnotimpactyouroverallacademicstandingwithIndianaStateUniversity.

  • ThesubmissionofanySemesterWithdrawalAuthorizationFormauthorizestheexchangeofyourrelevant personalinformationonyourbehalfbetweenpertinentUniversityoffices.
  • Ifyouareafinancialaidrecipientthatwithdrawsafteratermhasstarted,federalandstateregulationsrequirethatpartofthefundsreceivedmaybereturnedtotheassistanceprogram.TheOfficeofStudentFinancialAidwilldeterminetheamount,ifany,ofyouraidtoreturntotheappropriateprogrambasedonfederalandstate guidelines.
  • Basedontheeffectivedateof yourwithdrawal, youracademicfeeswill beadjustedaccordingtoISU's publishedrefundpolicyasapprovedbytheBoardofTrustees.TheamountofyourrefundmaybereducedbyfinancialobligationsatISUortoothersource(s)offinancialaid.Your accountbalancewillbeviewablethroughyour MyISUPortal.YourwithdrawaldoesnotabsolveyoufromanyoutstandingfinancialobligationstotheUniversity.
  • YourenrollmentstatusasreportedtotheNationalStudentClearinghousewillbeamendedtoreflectthe effectivewithdrawaldate.IfyouborrowedstudentloanswhileenrolledatISU,thismaycauseyoutoenteryourgraceperiodandbeginrepaymentofyourloans.Federalloanborrowerswhograduateor dropbelowhalftime enrollmentarerequiredtocompleteExitCounseling,anonlinesessionthat providesdetailsaboutrepayment.Pleasevisit
  • IfyouhaveahousingcontractwithResidentialLife,itisyourresponsibilitytocancelyourcontract.ResidentialLifecanbereachedat812-237-3993.
  • IfyouhaveaGraduateAssistantship,you shouldnotifytheawardingdepartmentofyourwithdrawal.
  • IfyouarereceivingVeteranEducationBenefits, yourcertificationwiththeUSDepartmentofVeteranAffairswillbeterminatedbasedontheeffectivewithdrawaldate.YoushouldcontacttheVAOfficeat1-888-442-4551orgoto
  • Ifyouareaninternationalstudent,yourwithdrawalwillnotbeprocesseduntilapprovedbyInternationalProgramsandServicesconsultwithIPSat812-237-2440.
  • Ifyouarea student athlete,yourwithdrawalwillnotbeprocesseduntilapprovedbyAthleticAcademicServices

consultwithAASat812-237-7601.

  • Beginning Fall 2015, no grades are assigned for processed withdrawals prior to the 7th day of fall or spring semester. For course(s) officially withdrawn between the 8th day and the last day to withdraw, the grade of “W” will be auto assigned. Grades of "W” are not included in the GPA calculation. Prior to Fall 2015, ifyouwithdrawpriorto10weeksintothestandardacademicterm(fall/spring),therewillbenogradesassignedtoyourcourses.After10weeksin astandardacademictermyouwillbeassignedgradesofW(Withdraw).W grades arenotcalculatedinyourtermorcumulativeGPA.Specificdeadlinedatesforwithdrawalswithnogradesassignedarepublishedeachtermat:
  • Youwillremainan activestudentintheIndianaStateUniversitysystemforatwo(2)yearperiodfromthatlast termyoucompleted.YouwillneedtobereadmittedthroughtheOfficeofAdmissionsonlyaftertwo (2)calendar yearshavepassedsincethelasttermyoucompletedatISU.Iftwo(2)yearshavenotpassed,youshould be eligibletoregisterduringnormalregistrationperiods.