Degree Student Course(s)/Semester Withdrawal Form

Please fill out this form if you wish to withdraw from a course(s) OR withdraw from the semester (all courses).

Note: If you are withdrawing for medical reasons, please fill out the Medical Withdrawal Form.

Last Name:

First Name:

Student ID:

Email:

Program:

Type of Withdrawal:

If you are enrolled in ONLY ONE course, please select semester (withdraw from ALL courses).

For a course(s) withdrawal, list which course(s):

Course #:

Course Name:

For a semester withdrawal, if you plan to return at a future date, enter the semester you would like to start courses again (Example: Fall 2021):

Fall

Enter year

Winter

Enter year

Spring

Enter year

Summer

Enter year

Check if applicable:

I am receiving some form of financial aid such as Stafford Loans, Pell Grants, Private Loans, etc. I understand that withdrawing will affect my financial aid. I also understand that I must maintain satisfactory academic progress in order to receive financial aid.I am using Veteran’s Benefits. I understand that withdrawing or reducing my credits will affect what I receive from the VA.

I understand that I am financially responsible for the tuition and fees charged, and that the
withdrawal I have requested will not result in a tuition refund.
Note: All students who receive financial aid are required to complete an exit interview with Financial Aid. Please contact Financial Aid at 617-747-2274 to set up your interview. Alternatively, you can complete this online by visiting www.studentloans.gov.

Decision:

Date Processed:

Contact Information