College Withdrawal Or Leave Of Absence Form Page 2

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___ Yes. Recipients of Federal Stafford and/or Perkins Loans are required to complete
online exit loan counseling. Please refer to the Student Loan Information Packet.
Have you received any type of
Check with Financial Aid for any additional costs that may be incurred due to a
Financial Aid?
withdrawal of leave of absence.
___ No.
Are you enrolled in the
___ Yes. Your contract will be canceled and your account will be adjusted to reflect
Tuition Payment Plan?
the amount paid through the plan. If you have over paid through Tuition Payment
Plan, you will be refunded in accordance to TCNJ's refund policy.
___ No.
Tuition Refund
___ I will receive 100% refund of tuition and fees for Fall 2016 by withdrawing from
Please select which statement is
the College on or before September 7, 2016.
applicable:
___ I will receive 75% refund of tuition and fees for Fall 2016 by withdrawing from
the College on or before September 20, 2016.
___ I will receive 50% refund of tuition and fees for Fall 2016 by withdrawing from
the College on or before October 4, 2016.
___ I will not receive any refund of tuition and fees for Fall 2016 by withdrawing from
the College after October 4, 2016.
Residential Housing
The refund date for housing will be determined by the date of check out from my room and key return (NOT date of
withdrawal from the College). I will review refund and check out procedures on the Residential Education and Housing
website. I understand that I must move out of my room within 24 hours of my withdrawal or Leave of Absence from the
College.
Please select which statement is applicable:
___ I am a residential student and I have read and understand the statements above.
___ I am not a residential student.
Grading
Please select which statement is applicable:
___ I will be dropped from all courses without a grade prior to September 7, 2016.
___ I will receive grade(s) of WD in all courses if I withdraw from the College before/on November 1, 2016.
___ I will receive grades WP or WF if I withdraw from the College after November 1, 2016 and before November 22, 2016.
* A student is unable to withdraw from the College after November 22, 2016. You will remain enrolled in the class and be
given a letter grade at the completion of the term.
Please select all that apply:
___ I have been advised of or have received the Student Loan Information Packet from the Office of Financial Assistance
(Financial Aid). If I do not have the Packet, I will contact Financial Aid.
___ I am expected to go to the Office of Student Accounts to review TCNJ’s Refund and Payment Policy.
___ I am aware that by taking a Leave of Absence of TWO or more consecutive semesters I will have to apply for re-entry into
the College.
Important Instructions to Submit:
All questions must be answered. Incomplete responses will delay the processing of this form.
Print and retain the completed form for your records.
TO SUBMIT: Please email this completed form as an attachment to
withdraw@tcnj.edu
You must submit this form using your TCNJ email account
E-mail is the official means of communication for The College of
.
New Jersey. Your 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.
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