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RELEASE LETTER APPLICATION FORM

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RELEASE LETTER APPLICATION FORM Powered By Docstoc
					                                                   WITHDRAWAL OF STUDIES
                                                 (FOR LOCAL STUDENTS ONLY)



PART A: STUDENT PARTICULAR


Name : _________________________________________                      Student’s ID : ___________________________

Faculty : ________________________________________                    Major : __________________________________

HP No : ___________________________                                   Trimester : ________________________________


1. Reason for withdrawal (Tick wherever applicable ):


                Obtained offer from other university, please select :
                ( Local University / Foreign University ; Full-Sponsored / Self-Sponsored)

                Cannot afford cost of studies

                Family matter and personal matter

                Academic reason

                Health problem

                Others (Please specify) _______________________________________________.




PART B: CLEARANCE
You should ensure that the following requirements have been met before leaving the University:

1)        STAD:
          1.1 Session with Counselor:

       ______________________________________________________________________________________________

       ______________________________________________________________________________________________

       ______________________________________________________________________________________________

         ……………………..…………………………………………………..                                       Date : ………………………………………..
         (Signature and Official Stamp of the Counselor)


         1.2 Hostel :

         Staying in Hostel: NO / YES                                           Remark : ……………………………………………………


         ……………………..…………………………………………………..                                       Date : ………………………………………..
         (Signature and Official Stamp of the STAD Officer)
     2)   Finance Department
          Outstanding balance : NO / YES                                      Outstanding amount : _________________________


          --------------------------------------------------------------      Date :____________________________
          (Signature and Official Stamp of the Finance Officer)


     3)   Library :
          Outstanding balance: NO / YES                                       Outstanding amount : _________________________


          -------------------------------------------------------------- Date :____________________________
           (Signature and Official Stamp of the Library Officer)


     PART C : CONFIRMATION

     1.   Should the Withdrawal of Studies Form is received during the Final Examination week, you are required to declare
          whether or not to attend the Examination:

                       YES. I would like to attend the Final Examination. Hence, I am understood that the withdrawal form shall
                       only be processed after the Senate Meeting.
                       NO. I would like to withdraw the subject(s) registered.


    3.    Collection of withdrawal letter:
                      Will come and collect at SSC . (The letter will be ready after 3 working days)

                       Would like the letter to be posted to ________________________________________________________
                       _______________________________________________________________________________________
                       _______________________________________________________________________________________


Student’s Signature: _______________________________________ Date:____________________________

REMINDER:
TAKE NOTICE that all outstanding fees should be settled before submitting the form. Should you fail to do so, the university
reserves the right to commence legal action for the recovery of the outstanding amount without any further notice to you.




PART D - OFFICE USE (ERU)
a) The withdrawal letter has been issued out and updated in the ICEMS on : __________________________

b) List of withdrawn subjects: (if applicable) & Withdrawn the subjects on: ___________________________

____________________________________________________________________________________________________

c) Transcript has been printed and attached with the QUIT Letter : YES / NO : Reason: _____________________

Updated by :                                                               Date :


Verified by :                                                              Date :

				
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