College Withdrawal Or Leave Of Absence Form


The College of New Jersey
Office of Records & Registration
P.O. Box 7718
Ewing, New Jersey 08628-0718
Phone: (609)771-2141 Fax: (609)637-5184
School Withdrawal/Leave of Absence Form- FALL 2016
All questions must be answered. Incomplete responses will delay the processing of this form.
TO SUBMIT: Please email this completed form as an attachment to
You must submit this form using your TCNJ email account. Submission can be verified by checking your Sent folder in your email
account. Additionally, you will receive a confirmation email from our office within one business day.
Date: _____________ (mm/dd/yyyy)
TCNJ PAWS ID: ______________
First Name: _______________________
Last Name: ___________________________
Campus Residence (if applicable) ___________________
Street Address: ________________________________________
Permanent Address:
Street Address 2: _______________________________________
City:_______________________ State:________ Zip Code:_____________
TCNJ E-Mail:
Alternate E-Mail: _______________________
Phone Number:
Cell Phone Number:
Current Career (Select one): __ Undergraduate
__ Graduate
__ Non-Matriculated
__ International Student
Primary Major: _______________________________
Select one: __ Withdrawing (not returning to the College)
__ Leave of Absence (returning the following semester)
Please indicate the semester you are leaving: __ Fall
__ Spring
Are you completing the current semester? __ Yes
__ No
What semester are you returning
__ Fall
__ Spring
__ Not Applicable __ Other_____________
Please Provide a brief explanation for your withdrawal/leave of absence:
It is my intention to withdraw from the College. I understand that I am required to complete an Exit Interview form from the
Office of Records and Registration. I also understand that I must satisfy any balance that I owe to the College. I must also
complete online exit loan counseling if I received any federal student loans while in attendance at TCNJ. I understand that as
a recipient of a TCNJ Scholarship, I should contact the Scholarship Coordinator in the Office of Student Financial Services for
an exit interview. I also understand that if I am a Tuition Protection Plan recipient I should contact the Director of Student
Accounts. If I fail to fulfill my obligations, holds will be placed on my records preventing me from registering for classes and
from receiving transcripts from the College. If I have attended the College for more than one semester, I understand that this
withdrawal does not exempt me from being reviewed for academic dismissal at the end of the fall or spring term. If I wish to
return to the College and two semesters or more have passed, I understand that I must apply to the Office of Admissions as a
re-entering student. As a re-entering student, my work will be evaluated using my past credentials, and I must be admitted
into an academic program. If this is my first semester at TCNJ, I must apply to the Office of Admissions to attend TCNJ in the
______ Initialing here acknowledges that I have read and I understand the above statements.
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