Withdrawal Form Header Image

Withdrawal Form

All information must be completed to be used for withdrawal from all courses.

*Fees May Apply*

Date*
What is your role?*

Term Information

Withdrawal from:*
Ex. 2020

Student Information

Student Name*
Ex. 1122334

Withdrawal Reason - 1

Withdrawal Reason - 2

Academic Information

John.Doe@mobap.edu

Acknowledgements - 1

You must agree to and acknowledge all of the following statements.

Do you receive institutional aid?*
Institutional aid will be prorated according to your charges.
Do you receive federal or state financial aid? Withdrawing after a term begins might require MBU to return all or part of your aid for the term.*
Also, if you received student loans or a TEACH grant while attending MBU, you must complete Loan Exit Counseling online at https://studentloans.gov and TEACH exit counseling at https://nslds.ed.gov
Do you receive VA, TRA, or WIOA benefits?*
Over-payments will have to be returned at a student's expense.
Do you understand that you may receive a "W" or "WF" for your courses in progress?*
A "WF" is a punitive grade and affects your GPA.
Are you a resident student?*
You will lose your room deposit if you are withdrawing during the contract period. Room and board will be refunded on a prorated basis. You are also responsible for outstanding long distance charges. Transcripts will be held until your account is paid in full. If you have a Housing Grant, future semester of eligibility are forfeited.
Are you a member of an MBU athletic team?*
You must return uniforms and equipment immediately. Transcripts will be held until returned.
Are you an International Student?*
International students must report to International Student Advisor or Director of Admissions.
By withdrawing you must agree to these terms:*
By withdrawing you must agree to these terms:
  I agree
You must pay any outstanding parking violations.
You must pay the balance of your account.
You must return library materials and pay any outstanding fines.
All Transcripts (Official and Unofficial) will be held until financial obligations are paid

Acknowledgements - 2

You must agree to and acknowledge all of the following statements.

Do you receive institutional aid?*
Institutional aid will be prorated according to your charges.
Do you receive federal or state financial aid? Withdrawing after a term begins might require MBU to return all or part of your aid for the term.*
Also, if you received student loans or a TEACH grant while attending MBU, you must complete Loan Exit Counseling online at https://studentloans.gov and TEACH exit counseling at https://nslds.ed.gov
Do you receive VA, TRA, or WIOA benefits?*
Over-payments will have to be returned at a student's expense.
Do you understand that you may receive a "W" or "WF" for your courses in progress?*
A "WF" is a punitive grade and affects your GPA.
Are you a resident student?*
You will lose your room deposit if you are withdrawing during the contract period. Room and board will be refunded on a prorated basis. You are also responsible for outstanding long distance charges. Transcripts will be held until your account is paid in full. If you have a Housing Grant, future semester of eligibility are forfeited.
Are you a member of an MBU athletic team?*
You must return uniforms and equipment immediately. Transcripts will be held until returned.
Are you an International Student?*
International students must report to International Student Advisor or Director of Admissions.
By withdrawing you must agree to these terms:*
By withdrawing you must agree to these terms:
  I agree
You must pay any outstanding parking violations.
You must pay the balance of your account.
You must return library materials and pay any outstanding fines.
All Transcripts (Official and Unofficial) will be held until financial obligations are paid

Student Signature - 1

Use your mouse or finger to draw your signature above
Date*

Student Signature - 2

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Date*

Advisor Signature

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Date*

Records Signature

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Date*

Resident Life Signature

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Date*

Financial Aid Signature

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Date*

Business Office Signature

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Date*
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