Submitted Sunday, May 28, 2023 

Important: Please read the information below before completing the withdraw form.

Use this form if you are dropping to zero credits. If you are still enrolled in one or more courses this term or semester, use the Drop/Add form.

You may be contacted by representatives from several offices including the Dean of Students, the business office, and/or the financial aid office. Each representative will provide you with advice and guidance to assist you in withdrawing, so be sure to include your most current contact information.

If you wish to withdraw from the university or are dropping all classes in a term or semester you must complete this form. You are not permitted to withdraw during the week of final exams. As long as you are in good standing and return in less than a year, you may register for classes without reapplying to the university.

Degree Level:

Term:

Year:

First Name:

Last Name:

Student ID:

Daytime Phone:

Email:

Current Address:

I am enrolled in:

I am dropping down to zero credits from:

Educational Plans:

Please select you primary reason for withdrawal. 

Other reasons that contributed to you decision. Check all that apply.

Are there any additional reasons for your withdrawal from Capitol?:

What, if anything, might Capitol have done to better help you obtain your educational goals?:

How is your tuition paid? Check all that apply:

I understand that as a result of withdrawing, my financial aid or VA education benefits may be modified or cancelled. Initial here:

I understand that if I have a sponsor or agreement, it may be adjusted or forfeited and I am personally responsible for tuition. Initial here:

I understand that I am personally responsible for the tuition charges I have incurred during my enrollment at Capitol Technology University. Initial here: