STEP 1 REQUEST FOR WITHDRAWAL FROM WOU
Today’s Date Term &Year Withdrawal is Requested
Full name (print) SID
Last Name First Name Student Identification Number
Mailing Address Phone
Street Address or PO Box
City State Zip Country
I hereby apply to withdraw from WOU as a student and request a refund of tuition and fees, if applicable, as
established by the administrative rule process.
Reason for Withdrawal (please be specific):
List Courses For Which You Are Registered:
CRN Prefix/ No. Did you attend at least one session of the class?
Do you plan to return to WOU? Yes No If yes, when do you plan to return?
STUDENT SIGNATURE DATE
STEP 2 Go to the Vice President for Student Affairs Office (Werner University Center) for initial approval of
Vice President for Student Affairs Date
STEP 3 Go to the office of University Housing (Ackerman Hall) if you are currently living in the residence halls
or on-campus apartments. Skip this step if you do not live on campus.
University Housing Date Petition given to student: Yes
STEP 4 Go to Financial Aid (Administration Building) to verify Financial Aid.
Financial Aid Date Aid No Aid
STEP 5 Go to the Business Office (Administration Building) to confirm current account balance.
Business Office Date Account Balance $
: STEP 6 Return this form to the Registrar’s Office for review and final approval.
For Office Use Only:
Date Received: % Refund Official Date of Withdrawal By
Amount Refunded $ By: Date:
Office of the Registrar
345 North Monmouth Avenue Monmouth, Oregon 97361 503-838-8327 Fax: 503-838-9696 www.wou.edu
form revised 1.12.12
BEFORE YOU FINALIZE YOUR DECISION:
Withdrawing from the University is a major decision. Other alternatives may be more beneficial to you
than a full withdrawal from school. WOU faculty and staff are available to help you in this decision.
A student may withdraw from the University without being responsible for grades up to the scheduled date shown
in the academic calendar. After that date, a student may be allowed to withdraw without academic penalty only if
mitigating circumstances exist (accident, prolonged illness, etc.). Verification, with supporting documentation,
must be submitted to the Office of the Registrar for consideration.
University Housing charges will continue to accrue until a student formally checks out of on-campus residence
If a student attends one or more classes, the student must follow the procedure for withdrawal as follows:
Complete the upper portion of this form.
Obtain clearance from the Vice President for Student Affairs office, University Housing, Financial Aid and
the Business office.
International students need written permission from the international office to withdraw from the university.
Return this form to the Registrar’s Office, Admin 106. All withdrawal determinations will be based upon the
date this form is returned to the Office of the Registrar unless an alternate date is specified by the Registrar
due to mitigating circumstances.
FINANCIAL AID REPAYMENT:
Financial aid recipients withdrawing before the 60% point of the term may be required to repay some or all of the
aid they received for the term. In addition to payment, students who withdraw may need to appeal to the Financial
Aid Office if they wish to be considered for aid in subsequent terms. Additional information about withdrawing
and financial aid is available at the Financial Aid Office.
Tuition and fee refunds are based on a refund schedule established by Western Oregon University. A copy of the
refund schedule may be viewed by any member of the public in the Office of Business Services during normal
business hours or on the web at www.wou.edu/student/finaid/tuition_fees/tuition_fees.php .
Any claim for refund other than indicated in the official refund schedule must be made in writing before the close
of the term in which the claim originated. The Director of Business Services may consider exceptions when
properly evidenced mitigating circumstances exist.
If the withdrawal results in a refund, the refund will be applied to accounts due to the Western Oregon University.
The remaining balance, if any, will be sent to the student. The application of a refund to an account due does not
absolve the student of responsibility for any remaining amounts due the Oregon University System.