EASTERN MICHIGAN UNIVERSITY
Cancellation/Withdrawal Request

Please use to request cancellation of your registration or to withdraw from all classes for the semester. A mailed request is effective as of the postmark date. See the Student Guide in the Class schedule book for the University calendar, deadlines, and withdrawal policy information.

Please mail, fax or present this form to:
 
Certified mail is recommended!

Office of Records and Registration
303 Pierce Hall
Eastern Michigan University
Ypsilanti, MI 48197
Fax: 734.487.6808
  

If you would like a receipt for a mailed request, please enclose a self-addressed, stamped envelope.

Circle:
   SP    SU    FA    WI _____________________
Semester & Year of withdrawal        

______________________
            Today’s Date
________________        ___ UG or        ___ GR   
Student number		  

______________________
    Social Security Number

________________________________________
Last Name              First Name              Mid I.		  


REASON FOR CANCELLATION/WITHDRAWAL

Please check the one most important reason:

________________________________________
Permanent Street Address		   ___ Major or degree not offered at EMU [NO]
________________________________________
Permanent City                        State               Zip 		  ___ No longer wish to complete a degree [ND]
(_____)_______________________
Phone Number		   ___ Insufficient funds [IF]
    ___ Dissatisfied with instruction [DI]
    ___ Employment [EM]
    ___ Family responsibility [FM]
    ___ Illness or accident [HL]
    ___ Dissatisfied with services [DS]
    ___ Planned transfer to other college or University [TR]
    ___ Other – Please specify below: [OT]
    __________________________________
                Student signature