College Withdrawal Or Leave Of Absence Form printable pdf download

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

withdraw@tcnj.edu

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:

_____________@tcnj.edu

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

future.

______ Initialing here acknowledges that I have read and I understand the above statements.

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College Withdrawal Or Leave Of Absence Form

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