WORK STUDY WITHDRAWAL REQUEST
Date:____/____/____
Student’s Name:___________________________________________________
Department:_________________________ Position:
Supervisor’s Name:
Last Working Day (be specific): ___/____/____
____ Please withdraw me from my current work study position.
OR
____ Please withdraw me from the work study program.
_____I have _____have not
position this semester.
performed any work for this Work-Study
I understand an exit interview with the Director of Human Resources may be
required for work study students withdrawing from their positions.
Student Signature:_________________________________________________
Supervisor Signature:
For Office Use Only:
Hours worked:______
Rate of Pay:_______
CC: Student Employment Office
Supervisor
Student
H: personnel/workstudy/ws withdrawal request
Total Earned:_______