Registrars Withdrawal Request Form

Records and Registration
Official Withdrawal Request

Year

Term:

Instructions: Please provide the information requested, to include required signatures, and return the completed form to the Registrar’s Office by the deadline date as listed in the Academic Calendar or the withdrawal will be voided and the grades earned will be posted to your permanent academic record.

Name

SUSLA Student ID#

Classification

Phone Number

Major

E-mail Address (@skymail.susla.edu)

Street Address

City

State

Zip

I am withdrawing from Southern University at Shreveport because of:

Other: (please explain)

Do you plan to return to SUSLA?

If yes, please state the term and year

Acknowledgements

• I understand that if I receive any type of financial aid (grants, scholarships, and/or loans) and officially withdraw from all classes after the official census date, I am required to have my financial aid prorated based on the U.S. Department of Education’s Federal Refund Policy. If I fall under this criterion, I will have the appropriate percentage of my financial aid returned to the appropriate fund and I am responsible to pay any balance remaining on the account as a result of this calculation.
• I understand that if I receive any type of funds from the Federal Title IV financial aid programs, the regulations requires that the date used to calculate the “Return to Title IV Funds” is the date I initiate the official withdrawal process as entered on this form by the Registrar’s Office.
• I understand that if I do not attend class and/or fail to officially withdraw, all charges are billed to me and my financial aid is cancelled.
• I understand that any hours from which I withdraw after the official census date (14th class day of the Fall and Spring semester/7th class day for the Summer semester) will count as attempted hours for the purposes of determining satisfactory academic progress and financial aid eligibility.
• I understand that my official withdrawal from the University will not be finalized and the status of any student loans/accounts can not be determined until this process has been completed.

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3050 Martin Luther King, Jr. Drive
Shreveport, Louisiana 71107
www.susla.edu

Phone: (318) 670-9229
FAX: (318) 670-6344
registraroffice@susla.edu