PRINT the following Sign and bring to the school.

Student Withdrawal Form.

Name:SS#--

Address: Drop Date:

Phone () Campus Program

Please, read and answer by checking one of the reasons below

	Decided to attend a different University
	Health related problems
	Job schedule
	Unhappy with the instructors
	The course was too demanding
	Relocating
	Tuition and fees were more than I could afford
	Courses not sufficiently challenging
	Could not find baby-sittting services
	Personal family problem
	Did not receive financial aid

Comments:

School Officer's Signature Student's Signature             Reported Non-attending by (professor) Date

FNU Reg. form 004E/2010 Rev. 06/15/2012