Penn State Office of the University Registrar

Withdrawal Form

**BEFORE WITHDRAWING CONSULT WITH YOUR ADVISER**

Please fill out this online form, print (using "Print Form" button at bottom of page), sign and follow the instructions below.

Reason:
Semester Effective:

I elect to withdraw from The Pennsylvania State University with the understanding of the following:

  • I am withdrawing from all my credit courses.
  • My course registration for all future semesters will be cancelled. I will need to be re-enrolled to return.
  • In the case of a summer-only withdrawal, fall registration will be maintained and re-enrollment is not necessary.
  • I understand that withdrawing might have a financial impact on my financial aid and health insurance benefits.
  • I understand that if I have borrowed federal or University loans during my career at Penn State, and I withdraw, even for just one fall or spring semester, that I will be required to complete the Loan Exit Interview at studentloans.gov in order to fulfill University Policy and federal regulations. If I do not complete the Loan Exit Interview, registration and transcript holds may be placed on my academic records.

Please review your entries on this form. If all of the information is entered correctly, please print (using "Print Form" button at bottom), sign and follow the instructions below.

Student Signature: _____________________________________ Date: ___________________

Instructions

  1. The withdrawal deadline is the last day of classes at 5:00 p.m. (ET). You may not withdraw after this deadline.
  2. * A copy of your military orders and letter from commanding officer must accompany the withdrawal form.
  3. ** Enter today's date as date last class attended, unless you can provide evidence that the date should be earlier.
  4. For the policy regarding tuition adjustments, go to: www.bursar.psu.edu/adjustments.cfm.
  5. Sign and mail or fax this form to:
    • For undergraduate students - The Registrar's Office, 112 Shields Building, University Park, PA 16802, fax 814-863-1929
    • For graduate students at University Park - Graduate Enrollment Services, 114 Kern Building, University Park, PA 16802, fax 814-863-4627

Revised 8/22/16