Complete Withdrawal Form

(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 or call (580) 327-8415.

Contact Information

Withdrawal Information

Your Enrollment Location *
Your Classification *
Have you attended classes? *
Have you completed an 8-week or 4-week class? *
Have you signed a dorm contract for this semester? *
Have you applied for financial aid (grants/loans/work)? *

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.

Is there anything Northwestern can do to assist you in maintaining your enrollment? *

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

Statement of Understanding *

By choosing YES below, you are agreeing that you understand all of the information provided above and that you are the person named above. By choosing NO, we cannot process your withdrawal via this online method, and you will need to make an appointment to discuss this matter.

Student's Electronic Signature *
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Phone: (580) 327-1700

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