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Withdrawal Form
To be completed by all full-time students in Certificate/Apprenticeship/Diploma/Preparatory programs who leave the program before the scheduled completion date of the semester.
* Students are encouraged to consult with counselling staff before completion of the form.
OEN (If known)   Student Number *

Select Title   Last Name *   First Name *
Second Name   Date of Birth  
Select a date from the calendar.
Apartment Number   Street Name and Number   City
Province or Country   Postal Code *   Phone *
Email *       Fax Number

This is required field
Campus   Program   Year
Please check off only one of the following
Select a date from the calendar.
Select a date from the calendar.
Please indicate the reason for withdrawal. This information is required for statistical purposes.
Freedom of Information The personal information collected on this is used for administrative purposes of the Registrar's Office under the authority of the Ontario Colleges of Applied Arts and Technology Act, R.S.O 2002, and regulations thereunder. Personal information will be protected in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA).