Total Withdraw Form - Colorado Mesa University
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1
2TOTAL WITHDRAWAL FOR SEMESTER
To be used in cases where a student is completely withdrawing from a
specific semester. This form does not withdraw the student from CMU.
NAME
Student ID#
LAST
FIRST
MI
ADDRESS
NO. AND STREET/P.O. BOX
CITY
STATE
ZIP
Fall 2015
PHONE (____)_____________________________(____)______________________________ SEMESTER:
U
U
HOME
WORK
REASON FOR WITHDRAWING:
**This form cannot be used for the accelerated online 7 week program, contact the Health Science Department**
GRADING POLICY: STUDENTS MAY WITHDRAW UP TO THE MID-POINT OF THE CLASSES BEING TAKEN and will receive grades of
"W". Students withdrawing after the midpoint of the classes will receive grades of "F".
REFUND POLICY FOR COMPLETE WITHDRAWAL: The act of registration constitutes a financial obligation to CMU regardless of
attendance.
a student pre-registers but officially withdraws before the first day of the semester, tuition and refundable fees will be refunded and all
1.
If
financial aid received must be repaid.
2.
The return of Title IV Funds: the federal government now requires all students withdrawing prior to the 60% point of enrollment to repay
unearned financial aid. This amount must be repaid prior to the student receiving any additional financial aid at Colorado Mesa University
or any other college or university. Non payment will affect future financial aid eligibility.
Unearned financial aid -Total Title IV financial aid disbursed (excluding workstudy) minus Earned title IV financial aid disbursed.
Earned financial aid -Total Title IV financial aid disbursed (excluding workstudy) multiplied by the percentage of the term completed.
3.
Non-Title IV funds such as scholarships or third-party payments will be adjusted according to Colorado Mesa University/donor policies.
4.
Housing or meal plan refunds will be applied in accordance with applicable contracts and Federal Financial Aid refund policies.
5.
Beginning the first day of the semester, if a student completely withdraws from
all classes
, the University will refund tuition and
U
U
refundable fees as follows based on the date student notifies the Registrar’s Office in writing.
Applies to all students who completely withdraw from all fall courses.
100% Refund of Tuition and Fees
All classes are dropped before the first day of the term.
(Request Outside of business hours must be submitted via FAX)
$225 Partial Tuition Assessment
At least one class officially started. All classes are dropped
(Newly matriculated student will be assessed the $135 matriculation
before the corresponding drop deadline(s).
fee plus a $90 Partial Tuition Assessment)
No Refund – Full payment of tuition and fees required for classes not
At least one class officially started and passed the corresponding
dropped by the appropriate deadline.
drop deadline.
See the chart on the back for specific dates.
REQUIRED
AUTHORIZED SIGNATURES
DATE
STUDENT ACCOUNTS OFFICE
__________________________________________________________
FINANCIAL AID OFFICE
__________________________________________________________
HOUSING OFFICE
__________________________________________________________
(If Applicable)
ADVISING & CAREER CENTER
__________________________________________________________
I am totally withdrawing from the current semester at Colorado Mesa University and have read and understand the grading policy and the
refund policy. I further understand that this action does not relieve me from other charges, fees, or fines as a result of my student status. In
addition, I have contacted the offices indicated above regarding my withdrawal.
I understand and will comply with the refund policies
U
indicated above
.
U
STUDENT SIGNATURE
DATE
OFFICE OF THE REGISTRAR SIGNATURE
DATE
OFFICE USE ONLY
REFUND/CHARGE
INITIALS
ASSESSED CHARGES OR SPECIAL INSTRUCTIONS
Student Accounts____________________________
_______________________________________________________________________
Financial Aid _______________________________
_______________________________________________________________________
Housing __________________________________
_______________________________________________________________________
COMMENTS _______________________________________________
EE
DD
DC P/T _____________
EFFECTIVE _____________
________________________________________________________
________________________________________________________
WD
WW
PROCESSED ___________
TO ACCT ___________
Checklist: SOAHOLD_____
SPAPERS (VA)______
SAAADMS_______
Form 40_____
SPAIDEN_____
Date Received:
SLARASG_____
E-Mail sent________
SFAREGS_______
Future Term Registration ______
SGASTDN______
R:\Registrar\Forms-Office CMU\Fillable Forms\CMU Currently Used Fillable Forms/Total Withdrawal - Revised June 23, 2015
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