NOTIFICATION OF WITHDRAWAL OR INTERRUPTION FROM STUDY

If you are considering withdrawing or interrupting your studies, you should meet with your Programme Leader* or
Head of Department to discuss your options; they will be able to advise you on any academic matters associated
with your plans. You should also meet with Registry who will be able to advise you on any financial and or
administrative matters associated with your plans. The completed form should be handed in to Registry who will
send you written confirmation of your withdrawal/interruption. Students in the Faculty of Dance should also have the
form signed by the Head of Dance Programmes, students in the Faculty of Music by the Assistant Director,
Programmes.

Section A – to be completed by student

Student’s name …………………………………………………………………………………..…………….…...………..…

Programme ………………………………………………………………………………………………………..……..……...

Application for (tick) Reason(s) for withdrawal/interruption (tick)

Withdrawal Interruption Medical/health grounds
Lack of funding
Today’s date Lack of financial support
/ /
Child care responsibilities
Year of Study (which year are you in? tick) Personal relating to family
1 2 3 4 Exclusion (not academic fail)
Transferred to another institution (withdrawal only)
Mode (tick) Dissatisfied with programme content (withdrawal only)
Part time Full time Dissatisfied with institution facilities (withdrawal only)
Dissatisfied with institution accommodation (withdrawal only)
Proposed start date of
withdrawal/interruption Other – do not wish to specify
/ / Other (please specify below)
…………………………………………………………………...……
Proposed return date (interruption only)
/ / ………………………………………………………………………...

Section B – to be completed by Programme Leader*/Head of Department during meeting

Programme Leader*/Head of Department to indicate main points of discussion with student…..….………………......

…………………………………………………………………………………………………………………..……………….…

…………………………………………………………………………………………………………………………..………….

………………………………………………………………………………………………………………………………….......

Programme Leader* or HoD name…………………………………………………..…………….…………………..……….

Programme Leader* or HoD signature….……….………..……………. / /

Head of Dance Programmes**/Assistant Director, Programmes*** signature

……………………………………………….……….………..……………. / /
*or Year Co-ordinator
**Faculty of Dance ***Faculty of Music

Section C – to be completed by Registry during meeting

Registry staff to indicate main points of discussion with student …………………………….……….………………......

…………………………………………………………………………………………………………………..……………….…

…………………………………………………………………………………………………………………………..………….

………………………………………………………………………………………………………………………………….......

Registry staff name….…………………………………………………………………………………….………………..…….

Registry staff signature ………….……….………..……………………… / /

By signing I confirm that I have discussed my withdrawal/interruption with my Programme Leader* and a member of
staff from Registry and understand all the implications of my withdrawal/interruption and accept any financial
arrangements agreed. I am aware that withdrawals/interruption periods will be notified to the assessment board.

Student’s signature ……………….……….……………………………… / /

REGISTRY OFFICE USE ONLY

During Registry meeting with student Notes
Discuss fee liability for current year/year of return
Check outstanding library loans/fines
Notify student of changes to 18+ Oyster (if applicable)
Tier 4 students only – confirm withdrawal/suspension of sponsorship
Eligibility for interim award (withdrawal only)
Confirm current address for withdrawal/interruption letter to be sent to
Notify student that Moodle access will be suspended/rescinded and ask if completed
any assessments recently so report form can be e-mailed to them.
After Registry meeting with student
Update enrolment status and fee on QL (For SFE students e-mail DM to update fee)
Update course lists
Complete SLC CoC (if applicable)
Notify DM, LW and CJ of any changes to fees
Written notification to library; confirm account clear
Written confirmation of withdrawal/interruption to student if library account clear
Notify House Services and Security
Notify UKVI (if applicable)
Notify Scheduling/Update CELCAT
Notify TFL (if applicable)
Notify relevant staff
Interruption due to mitigating circumstances only; notify MCP
Update assessment board grid
Update grade sheets
Update registers
Update # e-mail distribution lists
Remove/suspend Moodle account and e-mail student any recent report forms