Undergraduate College Withdrawal Form

Semester Withdrawing From*

Current SemesterNext Semester

Full Name*

First NameLast Name

Stonehill E-mail*

Forwarding E-mail*

Email that will be available after your withdrawal is processed.

Cell Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Student ID#*

Major(s)*

Class Year*

Cumulative GPA*

I entered Stonehill as a*

First Year StudentTransfer

This year I was a*

Campus ResidentCommuter

Do you plan to return to Stonehill at a later date?*

YesNo

Once a college withdrawal is processed, you will need to fill out the college Readmission Form and be approved for readmission before you will be able to return to the college. Approval will be granted once all eligibility factors are met, which may include any academic, student affairs, or medical clearances.

The Readmission Form is available from Oct 1st to Dec 1st for readmission for a Spring Semester and from March 1st to July 1st for readmission for a Fall Semester.

The fact that you decided to withdraw and the reason(s) why are very important to us. Please help us to assess our programs by answering the following questions:

Is this withdrawal for a medical reason?*

YesNo

Please explain your primary reason(s) for withdrawing:*

Have you made plans to transfer to another school?*

YesNo

What school are you transferring to?

The following are factors that students typically consider when leaving a college. Please rate these factors based on your own experiences at Stonehill. If you have neither the experience nor the knowledge about a particular factor, please indicate N/A (not applicable).

Factors:*

	Excellent	Above Average	Average	Below Average	Unsatifactory	N/A
Academic Advisement
Academic Performance
Academic Rigor
Academic Support Services
Tutoring
Writing Center
Disability Services
Amount of Contact with Faculty
Amount of Educational Loans/Debt
Amount of Financial Aid Received
Cost of Attendance
Cultural Opportunities
Enrollment Size
Extra Curricular Opportunities
General Education Requirements
Intellectual Stimulation
Location of Campus
Major Not Offered
Quality of Students
Quality of Teaching
Recreational Facilities
Residence/Living Accommodations
Social Life/Opportunities
Student Diversity

Please list in the order of importance to you, up to three (3) factors that, if changed for the better, would have encouraged you to stay at Stonehill.

Factor 1

Factor 2

Factor 3

Please use this space for additional comments:

Optional demographic information:

Do you identify as a:

Student of color (students who identify as Black, Afro-Caribbean, African American, East Asian, South Asian, Indian American, Asian American, Latinx/a/o, Hispanic American, Middle Eastern, Arab American, Native American, Alaskan Native)First-generation college student (a student whose parents did not complete a four-year, bachelor’s degree)International student (holding F-1 Visa status)

Please remember that all room keys must be returned to the Residence Life Office in Duffy 145. Failure to do so could result in additional fees or charges

I have questions, I would like a staff member to contact me.*

YesNo

Please sign to confirm your formal withdrawal from the College.

Click and hold with your mouse to sign.