Postgraduate withdrawal form (PDF - 64KB) - University of Birmingham

Registry, Academic ServicesRequest to Permanently WithdrawFor Postgraduate Taught/Lifelong Learning StudentsPermanently withdrawing from your studies means that you have decided to stopstudying at the University and that you have no intention of returning to continue yourprogramme of study in the future. Withdrawing from the University will have financialand visa implications.If you are considering permanently withdrawing from the University, you are stronglyadvised to meet with your Personal Tutor for advice and guidance before making afinal decision. If you have any queries or concerns that you were not able to resolvewith your Personal Tutor, you can make an appointment with the University SeniorTutor, Dr Regina Santos.Dr Santos meets students on a 1:1 basis in strictest confidence.To arrange a meeting with Dr Regina Santos, University Senior Tutor, please contacther by email or telephone:Email address: ust@contacts.bham.ac.uk Phone: 0121 414 7452Meetings will be strictly confidential, on a one to one basis, and where possible will bewithin 48 hours of making contact. The meeting will provide an opportunity to exploreall the options that may be available to you, such as taking a leave of absence ortransferring to a different programme of study.For more information visit the web page: http://www.as.bham.ac.uk/support/seniortutor.shtmlPlease tick this box if you have contacted the University Senior TutorOther sources of help and advice available:ARC (Advice and Representation Centre) based in the Guild of Students.Advice via www.studenthelp.bham.ac.uk or by visiting Enquiry ServicesIf after seeking advice you still wish to withdraw, you should complete this form and return it toEnquiry Services, Main Library (R.22 on the campus map), OR post it to Taught StudentAdministration, Registry, University of Birmingham, Edgbaston, Birmingham B15 2TT.Once your record has been updated you will receive confirmation to the email addressprovided below.Name:Student ID Number:Programme of Study: Year of Study (e.g.Year 2)Email Address:Telephone Number:Updated 22/01/20131

Reasons for withdrawing (optional): Please provide further information if you wish:MedicalFinancialTransfer to another UniversityTaking up employmentOther/personal reasonsLast date of attendance: This form cannot be accepted without this information, if unsureplease give an approximate date..……/…..…/………Student Visa InformationDo you currently hold a Student Visa?Yes No Not ApplicableIf yes, please provide the following details:Visa Number ………………………………….Visa Expiry Date ………………………Please note: If you are a visa student, your right to remain in the UK will be affectedby a withdrawal from study. All UK institutions are now legally required to report anychanges to an international student’s registration status to the UK Border Agency.You are advised to seek further advice from the International Students AdvisoryService prior to submitting your request to permanently withdraw. To speak to anadvisor you will need to make appointment with ISAS in advance by submitting anonline request via www.studenthelp.bham.ac.uk or phoning 0121 414 8464.Should you decide not to take immigration advice from this specialist service, pleasebe advised that you do so at entirely your own risk.Updated 22/01/20132

Accommodation:Are you currently living in University accommodation?YES/NO (delete as appropriate)Loans:Are you in receipt of a federal loan (Stafford or Plus)?appropriate)YES/NO (* delete asTuition Fees:Permanently withdrawing from study may affect your tuition fee liability. If youwould like information regarding the financial implications for your withdrawal,please email taughtstudentadministration@contacts.bham.ac.ukDeclaration: I confirm that I understand the implications of permanently withdrawingfrom the UniversitySigned:Date:…………………………………………………………………………………………………………….Signature of Personal Tutor, University Senior Tutor or Head of Department:Signed:Date:To be completed by Taught Student Administration:Database amended:…/……/……Confirmation email sent to student (if necessary):…/……/……Name:Signature:Updated 22/01/20133