Withdrawal Form – SUMMER 2024

This form is to withdraw from all courses for the semester and must be completed by the student. Review the entire Withdrawal Policy in the Bellarmine University Catalog for more information.

When a student officially withdraws, charges are adjusted according to the refund schedule, except in the case of medical withdrawal appeals, which are handled on a case-by-case basis. All fees are non-refundable. Refer to “Adjustments & Refunds of Tuition” in the University Course Catalog.

Institutional Financial Aid Refund Policy: When a student has institutional financial aid and withdraws during the time that a tuition refund is due, the student is eligible to keep the same percentage of the institutional financial aid they are charged for tuition. The remaining aid is refunded to the financial aid programs.

Withdrawal and refund dates for summer vary depending on the summer course dates and sessions. Refer to the summer 2024 academic calendar for specific withdrawal/refund dates.

Student Information:

Student ID Number _________________________________	Today’s Date ____________________________

Last Name ________________________________________	First Name ______________________________

Did you attend any classes this semester? _________________	Last date attended _________________________

Reason for Withdrawal _________________________________________________________________________

(If this is a Medical Withdrawal, please attach a letter outlining the circumstances which led you to your request.)

Check only one of the following boxes:

Check this box if this is a permanent withdrawal from Bellarmine University. (Any future courses for which you are registered will be dropped).

Check this box if you intend to return to Bellarmine University for courses in the Fall 2024 semester. Your status will remain active and you will be held to the Bellarmine Code of Conduct during your absence.

Student’s Signature ___________________________________________	Date ______________________

Notifications:

Please notify your advisor via email or phone that you have withdrawn. This includes: Student Success Center advisor, faculty advisor, or graduate program advisor, and if applicable, athlete advisor in the Academic Support Services for Student Athletes Office.

Students living on campus must make arrangements with Residential Life prior to moving out.

Medical Withdrawal Request:
If you are seeking a medical withdrawal as defined in the University’s Withdrawal Policy, you must complete this form and a Student Accounts Tuition Appeal Form, and submit them along with a letter outlining the circumstances which led to your request and any relevant documentation to support it. Your withdrawal will be processed upon receipt of this form in the Registrar’s Office and your letter will be reviewed by the Dean of Students (or their designee) to determine if you quality for a medical withdrawal. The Dean of Students Office can advise you with this process should you need assistance.

Active Duty Withdrawal Request:
If you have been called to active duty and need to withdraw from all classes, complete this form and a Student Accounts Tuition Appeal Form, and submit them along with a copy of your military orders.

Submit completed form to the Registrar’s Office at
registrar@bellarmine.edu or in-person, Horrigan Hall 205

Date Received in Registrar’s Office _______________