UNDERGRADUATE APPLICATION FOR RETROACTIVE WITHDRAWAL
(Within Current Semester Only)

Mail to: UNC at Pembroke
              Office of the Registrar
              P.O. Box 1510
              Pembroke, NC 28372
or Fax:  910-521-6328

Withdrawing from the University
Up to the last day to receive a W in a course, a student may complete a “Request for Withdrawal” form, available from the Office of the Registrar.
The student should get the required signatures, take the I.D. card to the Student Accounts Office, and return the form to the Office of the Registrar.
The University makes applicable refunds only after the withdrawal procedure is completed.

After the last day to receive a W in a course, the Office of Enrollment Management approves withdrawal from the University without academic
penalty only when unusual and documentable circumstances warrant. Unsatisfactory academic performance does not by itself meet the requirement.
As soon as possible, and no later than before the beginning of the last two weeks of classes in the semester, the student petitioning to withdraw
from the University must meet with the Vice-Chancellor for Enrollment Management, present the required documentation, and complete the necessary
forms. Approved requests receive a grade of W (Withdrawal) in all courses.  Students who stop attending classes without completing the withdrawal
procedure ordinarily receive an F in courses for which they are registered

Mailing Address:________________________________________________________________________________________  
                                Street                             Apt. #                                                     City                                        State                       Zip

On the reverse side, submit an explanation for your request and attach supporting documentation to this form.

The date that you submit this form or the date of notification, whichever is later, will be considered your last date of attendance for financial aid and student
account purposes.  Your financial aid may be adjusted if you withdraw before 60% of the semester is completed.  Student accounts will adjust tuition, fees,
and room and board charges based on a pro-rated basis.  (Please see the Office of the Controller at the following link: 
http://www.uncp.edu/co/

 


Student Signature Date

******************************************************************************************************************

     
     
Advisor / Department Chair Date   Student Accounts Date
     
     
Director of Housing & Residential Life Date   Director of Financial Aid Date
       
       
Director of Student Conduct Date      
       

 

******************************************************************************************************************

For Office Use Only:
Official Withdrawal Date:_______________________________   ID Card Received:___________________________________
     
Meal Plan Invalidated:___________________________________   Receipt Number:_________________ Date:_______________
     
     
REQUEST TO RECEIVE A GRADE OF “W” BASED UPON UNUSUAL CIRCUMSTANCES
     
APPROVED DENIED  
    Vice Chancellor for Enrollment Management Date
     
 
    University Registrar Date
     

Received by: ______________________________________ Date: _____________________________                          

CC:  Accounts Receivable Enrollment Management Financial Aid Office Music Department Chair (if withdrawing from Music Courses)
         
  Student Affairs  Student Copy  Advisor