Active Military Duty Request to Withdraw
(You will receive a copy of this request for your records)

ACC ID	NAME
Forwarding Address
	The address above is the one we will use to mail any future information or refunds.
E-mail address we can use to contact you

1. Copy of Military Orders Yes   No

If you do not have a copy of your MILITARY ORDERS or a FORWARDING ADDRESS, please mail or fax them to us as soon as possible. In order to process this request we must have a copy of your orders.

Send to: VA Certifying Official, Office of the Registrar
1801 N Cottonwood
Iola, KS 66749
620-365-5116 ext. 291
620-365-7406 (FAX)

2. WITHDRAW from all classes? Yes   No

I wish to WITHDRAW from the following CLASSES:

CLASS

NOTES

I wish to STAY ENROLLED in the following CLASSES:

CLASS

NOTES

3. Decisions about grading or incompletes are decisions made by the faculty on the basis of the work you have completed to date and the rules governing the course.

There is a full 100% refund for classes from which you withdraw and no adjustment for classes in which you remain enrolled, even if you are requesting a grade of incomplete in those classes.
4. If you have student financial aid, would you like for us to notify the Office of Student Financial Aid for you?

Not Applicable   Yes   No, I will contact Financial Aid myself

5. If you have a contract with Student Housing would you like for us to notify the Office of Student Housing for you?

Not Applicable   Yes   No, I will contact Housing myself