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Get Fanshawe Withdrawal Form 2008-2024

Student Withdrawal Form Office of the Registrar Rm. E1012 Fax 519-453-5021 Continuing Education Courses In order to withdraw from a Continuing Education course at Fanshawe College the student must complete Section A of this application and submit it to the Office of the Registrar Room E1012. The information is used for administrative and statistical purposes of the college and/or the ministries and agencies of the Government of Ontario and the Government of Canada. For further information please contact the Registrar Fanshawe College PO Box 7005 London ON N5Y 5R6 Telephone 519 452-4277. Section B Office Use Only Must be completed by Form Initiator Course Dates Start Date End Date Refund Policy Refund Deadline Withdrawal Date for graded courses only Refund eligibility is based on the Refund policy on the Course Section. According to College Policy 2-C-06 the effective date of the withdrawal is the date the Office of the Registrar receives the official documentation. Refund Completed by if applicable White Copy Office of the Registrar Yellow Copy Division Amount of Refund 2008 01 22. The withdrawal is effective the date the information is received in the Office of the Registrar. Section A Student Number Student s Name Surname First Name Telephone Home - Middle Name Business/Alternate Course Number DRIV-9025 Section 04LC Reason for Withdrawal Graded Course Regn.Term 08SCE Yes No Check one only please Financial Pursue other vocational or career goals Course related difficulties Health Personal Course cancelled Other Details I request that my registration at Fanshawe College in the course shown above be withdrawn. I hereby certify that I have returned all College property loaned assigned or consigned to me while I have been registered in this course. I understand that I am responsible for fees for the course according to policy listed in the course guidebook. Student s Signature Date FREEDOM OF INFORMATION AND PROTECTION OF INDIVIDUAL PRIVACY The information on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act 2002 Ontario Regulation 34/03. The withdrawal is effective the date the information is received in the Office of the Registrar. Section A Student Number Student s Name Surname First Name Telephone Home - Middle Name Business/Alternate Course Number DRIV-9025 Section 04LC Reason for Withdrawal Graded Course Regn*Term 08SCE Yes No Check one only please Financial Pursue other vocational or career goals Course related difficulties Health Personal Course cancelled Other Details I request that my registration at Fanshawe College in the course shown above be withdrawn* I hereby certify that I have returned all College property loaned assigned or consigned to me while I have been registered in this course. I understand that I am responsible for fees for the course according to policy listed in the course guidebook. Student s Signature Date FREEDOM OF INFORMATION AND PROTECTION OF INDIVIDUAL PRIVACY The information on this form is collected under the legal authority of the Ontario Colleges of Applied Arts and Technology Act 2002 Ontario Regulation 34/03. .

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