Withdrawal Form

• First Name
• Middle Name
• Last Name
• Student #
• NESL Email (addresses from @nesl.edu only)
• Personal Email (no @nesl.edu addresses, please)
• Home Phone
• Office Phone/ Ext

The Office of Financial Aid will mail you an exit packet to comply with federal regulations. If you are transferring to another school, please provide your new mailing address.

Street Address

Apt. or Suite #

City

State Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut District of Columbia Delaware Florida Fed. States Micronesia Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Northern Mariana Islands Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Palau Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Nova Scotia Northwest Territories (Canada) Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Armed Forces America Armed Forces Africa Armed Forces Middle East Armed Forces Europe Armed Forces Canada Armed Forces Pacific

Zip Code

• Division: Day Day Part-Time Evening Special Part-Time
• Year in School: (1) First Year (2) Second Year (3) Third Year (4) Fourth Year

Date of Withdrawal Request

Reason for Request to Terminate Enrollment

Withdrawal Process and Settlement of Accounts of Financial Obligations

Students who wish to withdraw are advised to read the Withdrawal Process (Rule A.5) and the Settlement of Accounts of Financial Obligations sections in the Student Handbook and reviewing the Voluntary Withdrawal webpage prior to hitting the Submit Button to request a withdrawal from the Director of Student Services.

Federal Title IV Funds (Federal Stafford & Perkins Loans)

Students who are receiving Federal Title IV funds (Federal Stafford and Perkins Loans) are subject to a federally mandated refund policy. A Title IV aid recipient wishing to withdraw should consult with the Director of Financial Aid to determine the impact this will have on his or her financial aid package. Examples utilizing the federal refund policy are available from the Director of Financial Aid.

Are you receiving Financial Aid? Yes No

Are you receiving a scholarship? Yes No

Did you attend summer school? Yes No

If so, what is the last date you attended summer class?