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.

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


Reason:
Semester of Withdrawal:

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. * For the policy regarding medical tuition adjustments, please visit the Office of the Bursar's website.
    *** Do Not Attach Any Medical Information to This Form ***
  3. ** A copy of your military orders and letter from commanding officer must accompany the withdrawal form.
  4. + Enter last class date attended: this date must be after the first day of classes. For courses that had never been attended please contact your department or advisor to complete an Administrative Course Cancellation Form.
  5. For the policy regarding tuition adjustments, please visit the Office of the Bursar's website.
  6. 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, or email registrar@psu.edu
    • For graduate students at University Park - Graduate Enrollment Services, 114 Kern Building, University Park, PA 16802, fax 814-863-4627, or email gswww@psu.edu

Revised 9/10/18