__ Graduate Assistantship
Withdrawal Authorization FormTo officially withdraw from all classes at AUM, please complete this form and submit it to the Registrar’s Office, Room 150 Taylor Center. Please be aware that you may not withdraw from any courses if you have a Cashier’s Hold.Student Name: __________________________________________________ Student ID: _______________________Current Address: __________________________________________________________________________________Phone #:___________________________________ Email Address: _________________________________________Check the PRIMARY reason for your decision to withdraw from Auburn University at Montgomery:__ Academic__ Health/Medical__ Personal__ Course Availability__ Military (with orders)__ Transfer to another school __ Employment__ Never attended Which School? ______________ Financial__ Other _____________________________________Additional comments regarding your withdrawal ____________________________________________________________________________________________________________________________________________________________Check all that apply.__ Graduate Assistantship – Notify the department awarding your assistantship of your intent to withdraw__ Financial Aid Received – Contact the Financial Aid Office at 334-244-3571__ Veterans Benefits Received – Contact the Veterans Affairs Office at 334-244-3288__ International Student - Contact the Office of?International Affairs at 334-244-3375__ Student Athlete – Contact the faculty athletic representative at 334-244-3787Please read each item carefully and initial that you understand the terms and conditions:InitialsI understand that even though I am withdrawing from AUM, I am responsible for all outstanding______ obligations to the University.I understand that if I live in the residence halls, it is my responsibility to meet with the ______ Housing Department to complete any required paperworkWithdrawal from classes may impact financial aid. You are encouraged to contact financial aid ______ to understand exactly how your withdrawal will affect your financial aid eligibility.For important refund dates, please refer to understand that I am withdrawing from all of my classes in which I am currently enrolled:Student Signature: ______________________________________________________ Date: ____________________ ................
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