UNIVERSITY OF THE VIRGIN ISLANDS 
Access & Enrollment Services 
 
 
 
 
 
 
 
 
Note: This form is to be completed only if the student is completely withdrawing from all courses at the 
university. Please email completed form to the Registrar’s Office at registrar@uvi.edu. 
 
 
 
 
 
 
 
 
 
 
 
    Name (Last, First) _________________________________________Student ID Number __________________________  
 
 
    Mailing Address: ____________________________________________________________________________________ 
    
    Email Address: ___________________________________________Telephone Contact: __________________________          
 
    Reason for Withdrawal: ____________________________________________________________________________________ 
 
 
 
 
 
 
   
Please Fill All Appropriate Spaces with the Correct Codes. See Codes Above 
 
DISCLAIMER: 
By signing this form, you are confirming that you are aware of the consequences of your decision on both academic and 
financial grounds.   
 
______________________________________________________________ 
 
 
Student Signature                                Date 
 
 
 
CODE 
CRN# 
SUBJECT 
TITLE OF COURSE 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Are you matriculated?  Yes □ No □     
 
Are you receiving Financial Aid?   Yes □ No □    
Are you a Veteran?       Yes □ No □     
 
Are you an International Student? Yes □ No □     
 
Did you ever attend?     Yes □ No □            
□Spring 20___   □Summer 20___    □Fall 20___   
CODES:   W = Complete Withdrawal      ***AW = Administrative Withdrawal (***Dean’s Approval is required) 
WITHDRAWAL FORM 
OFFICE USE ONLY 
___________________________   
              ___________________ 
Authorized Personnel  
 
 
Date