Office of Admissions

Application Withdrawal Request Form

indicates a required field.

Personal Information

Student Name
Campus ID Number
Application Term Semester
Application Term Year
What is your reason for withdrawal?	Financial reasons No longer interested Personal reasons Attending other college or university Name: Other. Please specify:

Additional Information

You will receive an email confirmation that your request has been processed. If you do not receive that email within 2-3 business days, please contact the Office of Admissions.

Please send copies of this form to the following departments:	Financial Aid Housing & Residential Programs Registrar's Office OneCard

Please send copies of this form to the following departments:

Financial Aid

Housing & Residential Programs

Registrar's Office

OneCard

Consent

	My electronic submission of this form demonstrates that I am the student named in this form and all the information contained herein is accurate and current.
Signature
Date

Who Are You?

Application Withdrawal Request Form

My electronic submission of this form demonstrates that I am the student named in this form and all the information contained herein is accurate and current.

Angelo State University

Who Are You?

Application Withdrawal Request Form

My electronic submission of this form demonstrates that I am the student named in this form and all the information contained herein is accurate and current.

Angelo State University

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