Withdrawal Form (All Taught Students) Academic Registry Student Records and Operations
This form should be used to request permanent withdrawal from the University. Once completed, this form should be returned to your School administrators; contact details can be found on the Student Self Service www.lboro.ac.uk/services/registry/self-service/ under My Programme and Staff Contacts. Before submitting your request, you may wish to make an appointment with Student Advice and Support to discuss the financial and Immigration implications of your request Please ensure that the form is completed in full and that all dates are accurate. Full-time students that withdraw from the University are liable for a proportion of their tuition fee in accordance with Regulation XVI , paragraph 4.5, see overleaf for details. Part-time students that withdraw from the University are liable for a proportion of their tuition fee on a modular basis.
1. Name	2. ID Number
3. School/Department
4. Current Programme
5. Withdrawal options 5.1 I wish to withdraw permanently from the University Date of Withdrawal / / 5.2 I wish to transfer to another University. Name of University Start Date / /
6. Please indicate your main reason for withdrawing Main Reason Main Reason The course content was not what I expected Health reasons The course was too difficult Financial reasons Going into employment Other personal reasons Other / Further information (please give details about the reason for your request – continue on a separate sheet if necessary)
7. Please indicate below who you have discussed your withdrawal plans with Yes No Yes No Academic/Administrative staff member in the School/Department Academic Registry staff Student Wellbeing & Inclusivity/Student Advice & Support Hall Warden (if in hall) Chaplaincy, Medical Centre Accommodation Services
8. STUDENT DECLARATION I confirm that I have discussed my plans with my School/Department and wish to withdraw permanently from the University. I understand this does not constitute a release from my licence/contract for halls of residence or private sector accommodation. I further understand that I may be liable for a proportion of my tuition fees and that the University, as appropriate, will inform Student Finance /Home Office of my new circumstances and that this may have financial/immigration implications for me. Print Name: Signature: Date: / /
9. TABLE OF PROPORTIONED TUITION FEES FOR FULL-TIME STUDENTS PART-TIME STUDENTS WILL BE CHARGED ON A MODULAR BASIS. Fees are pro-rated as follows: Within 4 weeks of start of term >4 weeks but during Term 1 During Term 2 During Term 3 During Term 4 UK/ UG 0% 25% 50% 100% N/A Int UG 0% 33% 66% 100% N/A UK/Int PGT 0% 25% 50% 75% 100% Relevant authorities (e.g. Student Finance and the Home Office) will be informed of the student’s withdrawal.
10. School Confirmation (to be completed by the Programme Director) I confirm that the student has discussed their wish to withdraw permanently from the University. Print Name: Signature: Date: / / 10.1 School Confirmation (to be completed by the Administrator) I confirm that the student has discussed their wish to withdraw permanently from the University. Print Name: Signature: Date: / /