Wilson Center for Academic Advising and Learning Assistance

P. O. Box 2580, State University, AR 72467 Phone: 870-972-3001|Fax: 870-972-3414| Email: wilsonadvising@astate.edu

University Withdrawal

Withdrawal from A-State: The completion of this form will withdraw you from ALL courses for which you are enrolled during the current term. Students who do not want to drop

all courses can make individual schedule changes through their Self-Service account. If you are enrolled through Academic Partnerships (A-State Online), contact Academic

Partnerships at (870) 972-2920 to discuss the withdrawal process for online students. Please read through the information below to understand the withdrawal process.

NOTE: If you contact the Wilson Advising Center to request the withdrawal form be sent to you, we will first complete the gray area and forward the form to you for completion.

You will then follow the instructions below to complete the withdrawal process.

NOTE: If you initiate the process by submitting the form to our office first, we will complete the gray area upon receipt and return it to you to complete the remaining steps of the

process. The form will have to be submitted back to our office a second time for final processing.

Instructions 1. You will need to download and save the form to your computer then open it with Adobe or any Free PDF reader.

2. Fill in your Name (Last, First), Student ID Number, Permanent Address, Phone Number, Student Email Address and Fax Number if applicable, so that we can return the form to you for signatures.

3. Select a reason for withdrawing from the University from the options listed or add your reason under other.

4. Complete all areas listed below and return the form to the Wilson Advising Center via email to jamiewray@astate.edu. You do not have to fill in anything in the gray area.

• If you owe a balance to the university, contact the Treasurer’s Office at (870) 972-2285 to discuss payment arrangements.

• If you receive student loans or scholarships, contact Financial Aid at (870) 972-2310 to speak to a financial counselor.

• If you are contracted through University Housing, contact (870) 972-2042 to speak with a housing representative.

• If you have books/materials checked out from the library, contact the Dean B. Ellis Library at (870)-972-2460 to speak with a representative.

• If you are enrolled through Transition Studies, contact Transition Studies at (870) 972-2080 to speak with a program representative.

• If you are a student athlete, contact Athletic Compliance at (870) 972-2813 to speak with an athletic coordinator.

• If you are an international student, contact International Programs at (870)-972-2329 to speak with a representative.

• If you are enrolled through the Restart Program, contact the Wilson Advising Center at (870) 972-3001 to speak with your Restart Instructor.

• If you are a graduate student, contact the department of your graduate program to discuss the withdrawal and the process to return.

5. Return the form with a copy of your picture ID (student or state issued ID will suffice) via student email to jamiewray@astate.edu or fax form to 870-972-3414 or click "Submit Form" at the bottom of this page.

6. Please call (870) 972-3001 before 5:00 PM the day you return your completed withdrawal form to verify that it was received. The withdrawal will not be processed if the form is not

completed and returned by the void date listed.

Withdrawal Application – Arkansas State University

_______________________________________________/__________________________________________________ I I I I I I I I I

Name: Last First Student ID Number

____________________________________________ __________________________________________ _____________________________________________

Major Classification: (FR, SO, JR, SR, PD) Semester (withdrawal is for semester listed only)

____________________________/__________/ ( ) _________________________________________________________________________________

Permanent Address: Number and Street City State Zip Phone

Fax: ( ) ___________________________________

Reason(s) for withdrawal: Print # 1 next to your main reason.

Marriage Medical Conflict with work Child Care Problems Military Financial aid Low grades Lack of interest Conflict with instructor Other: __________________________ Other money problems Transferring Transportation problems Moving for another reason ____________________________________

Withdrawal will be nullified if not filled out completely and returned to Wilson Advising Center by the void date indicated below. Return via student email to jamiewray@astate.edu

Student Signature ___________________________________________________________________________ Date: _____________/_____________/_____________

Void by 5PM ________Treasurer’s Office _________Financial Aid ________University Housing _________Library

________Transition Studies _________Athletics ________International Programs _________Restart

________Graduate Program _________Wilson Advising ________Administrative Withdrawal _________Accepted

End Date

STUDENT ACCOUNT BALANCE

Amount Owed $ These charges are subject to change. Outstanding fees or refunds may not be calculated and may not be reflected on this statement. There may be changes such as housing or financial aid repayment. Registration and transcripts will be held on any unpaid balance.

First payment is due within 30 days of the withdrawal end date. Pay online by Self Service or mail checks to Treasurer’s Office* P.O. Box 2640, State University, AR 72467, (870) 972-2285

The student remains responsible for payment of these charges, and will be responsible for any reasonable attorney fees and costs associated with the collection of unpaid charges, which may include fees charged by a collection agency up to 50% of the unpaid charges collected by that agency.

Student Email: