Student Withdrawal Request Form – Pacific Theological College

This form is made available per student request and is to be submitted to the Office of the Registrar. Pending the approval of the request to withdraw, students are advised to attend classes until a decision has been communicated to you. The College will uphold the withdrawal date specified on this form unless you attend classes beyond the date given below. Tuition and fee adjustments will be made according to the PTC handbook regulations.

Student Information

Full Name *

First

Middle

Last

Mode of Study *

Part time
Full time

Fee Payment *

Private Student
Sponsored Student

Programme Registered *

What month & year did you begin studying? *

Name of Sponsor

Withdrawal Information

Intended Withdrawal Date *

Semester *

How many courses have you registered for? *

Please state reasons for withdrawal *

Note: All students requesting to withdraw for medical reasons are advised to attach professional reports & recommendations to this form.

Upload Documents Here (Optional)

Click or drag files to this area to upload. You can upload up to 3 files.

Signature *

Clear Signature

Upload Electronic Signature (Optional)

Click or drag a file to this area to upload.

Upload image file.

Date *

For Office Use Only

To be completed by Academic Office

Required Endorsement:

Signing below implies that you have communicated with the student all options available to him/her, you have sighted the reasons given above & any necessary documentation, and you are convinced that withdrawal is the most feasible optional at this point in time.

Academic Dean | Signature & Date

Advisor | Signature & Date

Authorised by:

Principal | Signature & Date