Florida University Southeast - Withdrawal Request Form Withdrawal Request Form Before completing and submitting this form we encourage you to discuss your decision with your Advisor/Coordinator. Please fill out the questions below carefully and make sure that all information provided are accurate. The official date of withdrawal will be when this form is submitted online and has been reviewed/acknowledged by a FUSE representative. A retrospective date will not be accepted. It is important that students complete and submit this form as soon as possible, should they decide to withdraw from their program. Name * Name First First Middle Middle Last Last Students Institutional Email: * Please enter your institutional email address (this is your first name initial, your last full name followed by @myfuse1.education) Personal Email: * Please submit your personal email address in order to receive confirmation of your Withdrawal from Florida University Southeast Phone number: * Semester and term of Withdrawal * Semester 1 - Term 1 Semister 1 - Term 2 Semester 2 - Term 3 Semister 2 - Term 4 Semister 3 - Term 5 Semister 3 - Term 6 Reasons for Withdrawal: * New employment/job responsibility Program not going as Expected Personal circumstances Family commitments Medical reasons Other Reasons for Withdrawal: Please check the box below to complete your application * I agree and hereby give notice that I wish to withdraw Signature (Full Name) * Clear If you are human, leave this field blank. Submit
