Student-Led Withdrawal from Study Form - UGPT Taught Students

Student-Led Withdrawal from Study Form - UGPT Taught Students

Application for Withdrawal from Study
Taught Students / Date form received by CAS Hub: / Academic Registry
Rev – July 2018
Before you withdraw
  • Think about your options and seek help as early as possible to ensure you are informed about the consequences of what you plan to do. You should note that Withdrawal from Study means permanently ceasing your studies and the process may affect both your accommodation, your tuition fees and any other related fees. The University is keen that you continue with your studies if you possibly can.

  • Consider an Interruption to Study or a Course Change and seek guidance or advice from UCLan’s support services and your Retention Lead. Withdrawal from Study means that you have decided to permanently discontinue your current course of study with no intention of resuming.

  • Visit The <i> for information and guidance concerning financial implications regarding your Tuition Fees. You are also advised to seek advice concerning accommodation, benefits and funding from The SU Advice Centre and if applicable, from your sponsor.

  • If you have made a final decision to withdraw permanently from your studies, you must let us know formally through completion of this form of what you are intending to do as soon as possible. Failure to inform UCLan in this way will mean that
  • Your Tuition Fee Liability will continue to accrue
  • UCLan will not be able to promptly notify the Student Loan Company or other relevant bodies of any changes in your circumstances

How do I apply to withdraw from study?
  1. Seek guidance on the application process from The <i>, your CAS Hub or your Academic Advisor and complete Section 1 with your details.

  1. If you are a Tier 4 International Student you must take this form to The <i> to book an <i> appointment to receive advice on how withdrawal from study impacts on your leave to remain.

  1. Arrange to meet with your Retention Lead taking this form along with you. You can find out who your Retention Lead is at

  1. Read through the declaration in Section 4 and sign the form, then submit this form to your CAS Hub for approval within 2 working days of your meeting with your Retention Lead.

Note: The above steps can be undertaken electronically and the Retention Lead meeting could take place via Skype or Telephone.
Section 1: Your details / For student completion only
Surname: / First Name(s):
Registration No: / Partner Institution/Campus:
Date of Birth: / Click or tap to enter a date. / Please indicate if you are:
Home: ☐ EU: ☐ Overseas/International: ☐
Course Name: / Year of Course:
e.g. Year 2
Mode of Attendance:
Full-Time: ☐ Part Time: ☐ Sandwich: ☐ Distance Learning: ☐ / I am a sponsored student: / Yes: ☐ No: ☐
Section 2: Tier 4 International Students Only
Confirmation is given that the above-named Student has received advice from The <i> in relation to their request to withdraw from study and the student Starfish Notes record has been updated. For Tier 4 International Students, withdrawal from study will mean students are required to leave the UK immediately. / STAMP
Date: / Click or tap to enter a date. /
Section 2A: For Cyprus Students Only
Financial Implications
Withdrawal may affect students’ future eligibility for full-time or part-time financial support, the funding package they are eligible for and the tuition fees charged. It is the student’s responsibility to investigate this; Please advise the student to check their funding and tuition fee position.
Date & Initials: / STAMP
Section 3: Retention Lead authorisation / For Retention Lead completion only
I authorise this Student’s withdrawal from study☐ / Date of withdrawal
  1. This is the date of the Retention meeting
  2. Retrospective withdrawals are not normally permitted, seek guidance from SRMT.
/ Click or tap to enter a date. /
Print Name: / Signed: / Date: / Click or tap to enter a date. /
Could the University have done anything to prevent this Student leaving? Yes: ☐ No: ☐
If yes, please specify: / With electronic completion, this is an expandable text field

Outline reasons for the Student’s withdrawal: / With electronic completion, this is an expandable text field

Main reason for withdrawal – select only one: / If there is more than one reason, please choose the most appropriate/significant option
  1. Transferring to another institution:☐
  2. Health issues: ☐
  3. Financial reasons: ☐
  4. Going into employment: ☐
  5. Travel difficulties (cost/time): ☐
  6. Problems with accommodation: ☐
  7. Level of access to study support: ☐
  8. Needs of dependants/childcare issues: ☐
/
  1. Chose the wrong course for me: ☐
  2. This was not my first choice of course: ☐
  3. The level of access to University support services: ☐
  4. The levels of provision of specialist equipment for the course: ☐
  5. The level of provision of library/computing resource facilities: ☐
  6. The way the course was taught and assessed did not suit me: ☐
  7. The level of provision of social facilities: ☐
  8. Other personal reasons: ☐

Section 4: Student Declaration / For student completion only
  • I note that withdrawing from my course of study at UCLan may affect my eligibility for full-time or part-time financial support, the funding package for which I am eligible and the tuition fees charged and that it is recommended that I seek advice from the UCLan Student Union regarding the wider financial implications.

  • I am aware that all guidance is provided in good faith based on the information held about my situation. I note that UCLan endeavours to ensure that guidance is accurate at the time it was given. However, it can be subject to change and responsibility cannot be accepted for any errors or omissions, for consequences arising from the use of the information, nor for decisions or updates made by government agencies. Should any information change, any guidance that I have already been given may no longer be applicable and I may be required to revisit The <i>.

  • In signing this form I confirm that I have investigated my circumstances in light of the changes requested above and understand the impact upon my academic studies.

Signed: / Date: / Click or tap to enter a date. /
Students must now submit this form immediately to their CAS Hub. Any delays could have financial implications
Section 5: Notification of Student Withdrawal / For CAS Hub completion only
Student Support No: / UCAS Code: (if known)
Reported all International student withdrawals to SICT () for UKVI reporting purposes? / Yes No
Reported when students who have declared a disability withdraw () or where a withdrawal is related to wellbeing or welfare matters ()? / Yes No
Informed Head of School, Executive Dean/PA to Executive Dean, Course Leader, Academic Advisor and Retention Lead? / Yes No
For NHS commissioned courses: NHS Business Services Unit informed through submission of BUR101W? / Yes No
If appropriate, has the Accommodation Office been informed ()? / Yes No
If appropriate, has the Research Council, Sponsor or Business Partner Unit been informed? / Yes No
CAS Hub Declaration: I confirm that I have processed the above withdrawal from study as detailed, updated the Banner Student Record system as appropriate, sent this form to copying in relevant Academic colleagues and other appropriate teams as detailed.
Name: / Date: / Position:
1 Fee adjustment details: / 2 Portal / 3 Other Comment / For SFFT completion only
Original Fee: / Revised Fee: / Pending
Submitted /
Comments:
Staff initials and date / Staff initials and date / Staff initials and date
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