RC Notice of Withdrawal Probation Discon Nov08

							                                                                          REGIONAL COLLEGE
                                                           NOTICE OF WITHDRAWAL, PROBATION
                                                                         & DISCONTINUATION
               Submit this completed form to the appropriate SIAST Continuing Education office
          when a student withdraws, is placed on probation, or is discontinued from a full-time program.
              Probationary and discontinuation letters issued by SIAST program head upon receipt of completed form

Delivery Organization
                                                                                                  Notification Form
Program Name:                                                       Location:

Program Start Date:                                                 Program End Date:


Student Name (in full):

Address:                                                            Date of Birth:
                                                                    Social Insurance
Town/City:
                                                                    Number:
Postal Code:


WITHDRAWAL, PROBATION OR
DISCONTINUATION DATE


        ACADEMIC PROBATION

        STUDENT INITIATED WITHDRAWAL
                     Failed Requirements 21          Moved 34                                Employment 60
                     Program Unsuitable 23           Legalities 35                           Training Related Employment 61
                     Program Difficulty 24           Financial 40                            Seeking Employment 62
                     Personal 30                     Sponsor Change/End 41                   Deceased 70
                     Child Care 31                   Health 50                               Reason Not Given 80
                     Family 32                       Personal Illness 51                     Other 90
                     Transportation 33               Family Illness 52

        REGIONAL COLLEGE INITIATED DISCONTINUATION (REQUIRED TO DISCONTINUE – RTD)
                        RTD Academic 20 (SIAST Policy A-1.3)            RTD Discipline 25 (SIAST Policy A-2.5)
                        RTD Absenteeism 22




Delivery organization authorized signature                       Date



SIAST Program Head signature                                     Date



REGISTRATION SERVICES USE ONLY:


Processing RS Representative                                             Date


REGIONAL COLLEGE NOTICE OF W ITHDRAWAL & DISCONTINUATION                                     LAST REVISED: NOVEMBER 26, 2007