Graduate Student Withdrawal

Student Name (Last, First & Middle)

Banner ID

Class Standing

	Graduate Student		Graduate, Continuing Education
	Doctoral Student		Graduate, Audit Only

Campus

CSB SJU

Student status for term

Term

Year

Withdrawal type

Effective Date

MM/DD/YYYY

Courses dropped or withdrawn

Permanent drop or withdraw?

	Permanent Drop
	Withdraw

Reason for withdrawal

Submitted by (name)

CSB/SJU email address

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