Date of Birth:
District Of Columbia
Northern Mariana Islands
I hereby withdraw my current enrollment at Western Connecticut State University for the semester indicated above.
I understand that this does not relieve me of any financial obligations to the University.
I have read and understand the University's refund policy as stated on the website at
Students living on campus are required to contact the Housing Office at 203.837.8531 to withdraw from housing.
A withdrawal could affect your eligibility to receive or maintain financial aid. For more information, contact the Financial Aid Office at 203.837.8580.
I understand that should I wish to return I must reapply through the Admissions office.
Reason for Withdrawal:
Grades for the Current Semester:
I wish to receive actual final grades for this semester.
I wish to receive W's as final grades for this semester (only if final exam week is not already in session).
I am not currently enrolled in courses
If enrolled Summer/Intersession Courses(s):
I wish to receive final grade(s) for course(s).
I wish to receive W's as final grades for this Summer/Intersession-only if prior to exams.
I am not enrolled in Summer/Intersession Courses
Withdrawals are effective the date this form is electronic submitted.
By selecting the "I Accept" button, you are are agreeing to sign this form electronically and that your typed signature is the legal equivalent of your manual signature.
Student signature (typed):
* Please review the information you have entered in the above form before clicking submit.
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