Student Name: ____________________________
PSU ID: ___________________________
_____Medical _____Military _____Other
Date Last Class Attended_____________
_____Fall _____Spring _____Summer _____Summer ONLY Year:_________
I elect to withdraw from The Pennsylvania State University with the understanding of the following:
- I am withdrawing from all my credit courses.
- My course registration for all future semesters will be cancelled. I will need to be re-enrolled to return.
- In the case of a summer-only withdrawal, fall registration will be maintained and re-enrollment is not necessary.
- I understand that withdrawing might have a financial impact on my financial aid and health insurance benefits.
- I understand that if I have borrowed federal or University loans during my career at Penn State, and I withdraw, even for just one fall or spring semester, that I will be required to complete the Loan Exit Interview on eLion (eLion.psu.edu) in order to fulfill University Policy and federal regulations. If I do not complete the Loan Exit Interview, registration and transcript holds may be placed on my academic records.
Student Signature: __________________________________________
- You may not withdraw after the last day of classes.
- *A copy of your military orders must accompany the withdrawal form.
- **Enter today's date as date last class attended, unless you can provide evidence that the date should be earlier.
- For the policy regarding tuition adjustments, go to: www.bursar.psu.edu/adjustments.cfm.
- Sign and mail or fax this form to:
- For undergraduate students at University Park - The Registrar's Office, 112 Shields Building, fax 814-863-1929
- For graduate students at University Park - Graduate Enrollment Services, 114 Kern Building, fax 814-863-4627
- For students at other campuses - The campus Registrar's Office or office of the campus Director of Academic Affairs
FOR OFFICE USE ONLY
NCRR _____ Blended _____