(For best results, please fill out this form using the Google Chrome Browser.)
Please answer all questions below as honestly and thoroughly as possible.
Upon hitting the "Submit" button, your information will be emailed to Student Services and Calleb Mosburg, the Dean of Student Affairs and Enrollment Management.
If you have questions, please do not hesitate to contact Mr. Mosburg at email@example.com or call (580) 327-8415.
Please be specific below in explaining your reasons for withdrawing. Examples include Financial, Family Illness, Job Conflict, Academic Problems, Quality of Instruction, Personal Reasons (please elaborate), Personal Illness, Transferring, Going to Work, Quality of Advising/Assistance, Quality of Campus Life, Moving, Attendance Problem, Loss of Scholarships, etc.
I understand this withdrawal could affect my: A. Late withdrawal charges, B. Academic grades and graduation, C. Financial aid or scholarships, D. Social security & V.A. benefits, E. Athletic eligibility, F. International student visa eligibility, G. Dormitory changes, H. Health insurance