Course Withdrawal Form - Montclair State University

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MONTCLAIR STATE UNIVERSITY – OFFICE OF THE REGISTRAR
NOTE TO STUDENTS: It is your responsibility to be aware of any credit
load restrictions that are associated with special programs , financial
COURSE WITHDRAWAL FORM
benefits, athletics, etc.
Student ID Number:
Semester/Year:
* Date of withdrawal is the date of receipt within the Office of the
Registrar or the U.S. postmark for those received through the U.S. mail.
** Courses which have been paid for and dropped before the first day of
Fill in full course number, section number and title of the course to be dropped:
class will be processed as 100% refunds.
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Refunds will be processed by Student Accounts within 5-8 weeks from
the date of withdrawal.
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SEE APPROPRIATE SCHEDULE OF COURSES BOOK FOR SPECIFIC
WITHDRAWAL AND REFUND DEADLINES.
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OFFICE USE ONLY
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Prior to the first day of class: ______________
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100% Refund: __________________________
50% Refund:
__________________________
Name and Address (Please Print)
No Refund: ____________________________
DATE PROCESSED ON SIS: _____________
Staff Initials:
*Date:
________________________________________________________
Student Signature
Date
SEE APPROPRIATE SCHEDULE OF COURSES BOOK FOR SPECIFIC
WITHDRAWAL AND REFUND DEADLINES ( )
Distribution: Original: Office of the Registrar / Copy: Student
W06/11

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