Request for Withdrawal from Graduate Studies
Freedom of Information
and Protection of Privacy
The information on this
form is collected under
the authority of
the University Act (RSBC
1996, c. 468) and is
needed to update your
student record and will
be used to document your
progress in an academic
program. If you have any
questions about the
collection, use and
disclosure of this
information please
contact the Director of
Graduate Admissions and
Records, Office of
Graduate Studies and
Postdoctoral Fellows,
778-782-3042 or by email
to gradstudies@sfu.ca.
This form must be accompanied by a copy of your written request to be
withdrawn from graduate studies. Please note that this form will not be
processed if you have outstanding fees.
Date of requestSemester for withdrawal (eg. Fall 2012)
Degree (eg. MA, MSc, PhD)
Graduate program name
Reason for withdrawal (optional)
STUDENT INFORMATION
o Student’s written request to withdraw is attached.
Student’s first name(s)
Student’s surname
Student number
Email
Home phone
Cell phone
Street address
City
Province/State
Country
Postal/Zip Code
I confirm that I have informed my senior supervisor (if applicable) and the
Graduate Program Chair or Director of the program of my decision to withdraw.
Please attach a copy of the emails informing the appropriate persons.
SIGNATURE
Student’s SignatureDate
RETROACTIVE WITHDRAWAL
Retroactive withdrawals are not normally approved unless the graduate program confirms
in writing that the student did not attend or use university resources as of the withdrawal
date, and the student provides written documentation of extenuating circumstances.
Requested retroactive date of withdrawal
Signature, Senior Supervisor
Revised April 2015