PRAIRIE VIEW A&M UNIVERSITY WITHDRAWAL FROM THE UNIVERSITY
(This form is to be used ONLY when a student drops all courses)
Term
Data
Freshman
Sophomore
Junior
Student ID
Spring
1st 8 weeks
2nd 8 weeks
16 weeks
Please Check Semester / Session Above
Classification (Please Check)
Major
Fall
1st 8 weeks
2nd 8 weeks
16 weeks
Senior
Graduate
PhD
Instructions on Back
Summer
1st 5 weeks
2nd 5 weeks
10 week
Enter Semester Year Below
Name
(Please Print)
Last
First
(
)
Mailing Address
Do you live in University Housing?
YES □
or NO □
Did you receive Financial Aid?
YES □
or NO □
Are you a Student Athlete?
(if YES you must obtain signature from
Athletic Compliance Office)
YES □
or NO □
MI
Phone Number
Email
REASON FOR WITHDRAWAL: Please check main reason for withdrawal
____
Academic Difficulty
____
Transferring to:
____________________________
Decided not to Continue my
education at this time
Disability Related Issues
On-Campus Housing Availability
____
____
____
____
____
____
____
____
____
____
Off-Campus Housing Availability
Health Issues (Self)
Health Issues (Family)
Financial Aid Issues/SAP
Work Conflict/Issues
Family Responsibilities
Childcare/Daycare Availability
____
____
____
Transportation Issues
Financial Issues
Other _____________________
__________________________
NOTE: Student must take the completed form to the Registrar’s Office by the deadline listed on the academic calendar located at www.pvamu.edu/calendars or the withdrawal will not be
accepted and grades will be assigned. Student may still be responsible for paying all or part of the tuition and fees depending on the date of the withdrawal.
CAUTION: Students withdrawing from all PVAMU classes after the 1st class day will be charged a percentage(%) of total tuition and fees based on the date of the withdrawal. Please refer to
the PVAMU Catalog or http://www.pvamu.edu/fsrv/treasury-services/refunds/student-withdrawal-refund-policy/
_________________________________________
Athletic Compliance
Date
_________________________________________
Financial Aid Advisor
Date
_________________________________________
Advisor/Dept. Head/or Academic Dean
Date
I understand that the Registrar’s Office will only process the semester and summer term(s) that I have checked above on this form
I also understand, if I have received a refund and/or the financial award is reduced due to the withdrawal, I may be responsible for returning
up to the full amount of the refund back to PVAMU as well as paying for a percentage or all of the tuition and fees. By checking the box I
acknowledge that I viewed the policies and procedures attached to this form.
_________________________________________________
Student Signature
Date
Registrar’s Office Use Only
Processed by:_____________
Date:___________________
Revised 1/2015
1.
2.
3.
4.
STUDENT ROUTING PROCESS FOR WITHDRAWAL
Obtain a signature from the Athletic Compliance Office (if
applicable).
Obtain a signature from your Financial Aid Advisor MSC
rd
3 Floor.
Obtain a signature from Advisor/Dept. Head/ Or Academic
Dean.
Step 1-3 MUST be completed before submitting the
Withdrawal Form to Registrar’s Office, MSC 3rd Floor.
Any student not attending the Main Campus, enrolled in
online programs, or students with health issues may fax the
form to 936-261-1051
OFFICIAL UNIVERSITY ACADEMIC WITHDRAWAL POLICY
Important Information for Students – READ CAREFULLY!





STUDENTS RECEIVING FINANCIAL AID must talk to a financial aid advisor before withdrawing.
Withdrawal from the university does not cancel all tuition and fees, but can substantially affect aid
eligibility. Failure to comply may result in the student owing a substantial sum.
INTERNATIONAL STUDENTS holding an F-1 or J-1 student visa must go to the Immigration
Services in Harrington Science Building the day you begin your withdrawal process. Immigration
Services will explain how withdrawing may affect your immigration and sponsored program status,
and will explain how readmission requirements affect you.
Once the student has completed the withdrawal form and the withdrawal has been accepted by the
Registrar, the student will be considered withdrawn from the University and will no longer be entitled
to services or facilities provided for the benefit of Prairie View A&M University students.
It is THE STUDENT’S responsibility to fulfill their obligations concerning financial aid,
balances due if applicable, and to return equipment and uniforms in order to avoid being billed,
holds being placed on your account, and or sent to collections if deemed necessary.
Please review the instructions below for contacting various service offices and contact those that apply
to you before you leave the University to ensure you leave in GOOD standing. Failure to clear with
the appropriate offices also may result in processing delays should the student decide to re-enroll at
a later date or require access to their academic record.
Financial Aid
3rd floor MSC
936-261-1000
Treasury Services
W.R. Banks, Suite 140
936-261-1890
Veterans Affairs
Anderson Hall 1st Floor, Room 107
936-261-1067
Auxiliary Services
MCS, Room 107
936-261-1700
Parking Management
Harrington Science Bldg., Room 117
936-261-1701
Immigration Services
Harrington Science Bldg., Room 107D
936-261-1725
Athletic Compliance
Harrington Science Bldg., Room 116
936-261-2650
Academic Affairs
A.I. Thomas Bldg., Suite 212
936-261-2175
Student Affairs
Evans Hall, Room 305
936-261-3550
Registrar’s Office
Memorial Student Center, 3rd Floor
936-261-1000
Admissions Office
Anderson Hall, 1st Floor
936-261-1000
…if you have received financial aid assistance in the form of a scholarship, loan, or
other federal, state, or University aid (including academic scholarships). Failure to
contact financial aid could affect your eligibility for future assistance.
…you may owe fees or loans to the University.
…if you receive education benefits under the G.I. Bill or Hazelwood exemption.
…if you are living in a resident hall on campus. You must make arrangements to
vacate your apartment…If you have a meal plan any refunds due to you will be
prorated.
…if you wish to request a refund for a parking permit. You must surrender your
hang tag in order to receive a credit.
…if you are a foreign student.
…if you are a student athlete.
…if you have general academic questions.
…if you have student conduct questions.
…if you have processing questions.
…if you have any re-admittance questions.