UNIVERSITY OF THE VIRGIN ISLANDS
UNIVERSITY OF THE VIRGIN ISLANDS Access & Enrollment Services Note: This form is to be completed only if the student is completely withdrawing from all courses at the university. Please email completed form to the Registrar’s Office at registrar@uvi.edu. Name (Last, First) _________________________________________Student ID Number __________________________ Mailing Address: ____________________________________________________________________________________ Email Address: ___________________________________________Telephone Contact: __________________________ Reason for Withdrawal: ____________________________________________________________________________________ Please Fill All Appropriate Spaces with the Correct Codes. See Codes Above DISCLAIMER: By signing this form, you are confirming that you are aware of the consequences of your decision on both academic and financial grounds. ______________________________________________________________ Student Signature Date CODE CRN# SUBJECT TITLE OF COURSE Are you matriculated? Yes □ No □ Are you receiving Financial Aid? …
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UNIVERSITY OF THE VIRGIN ISLANDS Access & Enrollment Services Note: This form is to be completed only if the student is completely withdrawing from all courses at the university. Please email completed form to the Registrar’s Office at registrar@uvi.edu. Name (Last, First) _________________________________________Student ID Number __________________________ Mailing Address: ____________________________________________________________________________________ Email Address: ___________________________________________Telephone Contact: __________________________ Reason for Withdrawal: ____________________________________________________________________________________ Please Fill All Appropriate Spaces with the Correct Codes. See Codes Above DISCLAIMER: By signing this form, you are confirming that you are aware of the consequences of your decision on both academic and financial grounds. ______________________________________________________________ Student Signature Date CODE CRN# SUBJECT TITLE OF COURSE Are you matriculated? Yes □ No □ Are you receiving Financial Aid? Yes □ No □ Are you a Veteran? Yes □ No □ Are you an International Student? Yes □ No □ Did you ever attend? Yes □ No □ □Spring 20___ □Summer 20___ □Fall 20___ CODES: W = Complete Withdrawal ***AW = Administrative Withdrawal (***Dean’s Approval is required) WITHDRAWAL FORM OFFICE USE ONLY ___________________________ ___________________ Authorized Personnel Date