Intent to Withdraw Form

This form indicates my intent to withdraw from Bryn Athyn College. I understand that by submitting this form, I will be removed from all classes in which I am enrolled and am responsible for all tuition and fees according to the refund schedule. I also understand that my withdrawal may affect athletic eligibility, ability to remain in campus housing, use of campus facilities, and my current and/or future financial aid awards.

Once this form has been submitted the following offices will be notified: Financial Aid, Bursar, Dean of Students, Dean of Academics and Registrar. Should any department have follow up questions they will contact you individually.

BAC Email Address

First Name

Last Name

Birthdate

Phone Number:

Which term are you withdrawing from?

Do you currently live on campus?

Athlete?

Transferring to:

Dissatisfaction with:

Please Describe:

Do you plan to return in the future?

Yes

No

When?

Forwarding Address:

Country

Street

City

Region

Postal Code

Personal Email Address

Typing your full name in the signature field constitutes an electronic signature:

Student Signature

Today's Date

Best way to reach you in case follow up is needed:

Admissions

Intent to Withdraw Form