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Get Canada Seneca College Request to Withdraw from a Full-Time Program 2018-2024

Registration Records Office Fax Newnham 416 491-9187 Seneca York 416 661-1947 King 905 833-0730 Markham 905 940-4090 Request to Withdraw from a Full-Time Program NOTE 1. In order to be eligible for a refund you must withdraw from the College and return this form to the Registration Office within the first ten days of scheduled classes. 2. This form must be signed by your Program Co-ordinator or Chair. PLEASE PRINT CLEARLY Telephone Number Current Program Sem Student Number Withdrawal Effective Month/Day/Year Last Name First Name Street Address Apt. Registration Records Office Fax Newnham 416 491-9187 Seneca York 416 661-1947 King 905 833-0730 Markham 905 940-4090 Request to Withdraw from a Full-Time Program NOTE 1. In order to be eligible for a refund you must withdraw from the College and return this form to the Registration Office within the first ten days of scheduled classes. 2. This form must be signed by your Program Co-ordinator or Chair. PLEASE PRINT CLEARLY Telephone Number Current Program Sem Student Number Withdrawal Effective Month/Day/Year Last Name First Name Street Address Apt. / Unit No* City / Town Province Postal Code Reason for Withdrawal OUTSTANDING COLLEGE FEES If I am withdrawing from the College after the 10th day of scheduled classes and my fees have not been paid in full I understand such fees must still be paid* Overdue accounts will be sent to a collection agency if arrangements for payment have not been made. If I am in receipt of OSAP funds any refund due to me will be sent to my bank to repay a portion of my student loan* FREEDOM OF INFORMATION AND PROTECTION OF PRIVACY ACT Personal information on this form is collected in accordance with sections 21 39 and 49 of the Freedom of Information and Protection of Privacy Act and under the legal authority of the Ministry of Training Colleges and Universities Act R*S*O. 1990 and the Ontario Colleges of Applied Arts and Technology Act 2002 Regulation 34/03 and may be used and/or disclosed for administrative statistical and/or research purposes of the College and/or the ministries or agencies of the Government of Ontario and the Government of Canada* If you have any questions concerning the collection and use of personal information please contact the Privacy Office at 416 491-5050 extension 77846 or email privacyoffice senecacollege. ca* Student Signature Date Program Co-ordinator Signature Chair Signature For OFFICE USE ONLY Withdrawal Code Processed Withdrawal Date Advisor Initials and Date OSAP Refund NO YES Bank Amount Student Date Processed Initials Original Student File Copy Financial Aid TO BE DUPLICATED ONLY BY REGISTRATION RECORDS* Last Revised March 13/12. Registration Records Office Fax Newnham 416 491-9187 Seneca York 416 661-1947 King 905 833-0730 Markham 905 940-4090 Request to Withdraw from a Full-Time Program NOTE 1. In order to be eligible for a refund you must withdraw from the College and return this form to the Registration Office within the first ten days of scheduled classes.

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