Alaska Withdrawal of Application for Services

State:
Alaska
Control #:
AK-FORM-04-1090
Format:
PDF
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Description

Withdrawal of Application for Services

Alaska Withdrawal of Application for Services is a process used by individuals to withdraw an existing application for services with the State of Alaska. Withdrawing an application means that the individual no longer wishes to receive services or benefits from the State of Alaska, and their application will be terminated. There are two types of Alaska Withdrawal of Application for Services: voluntary withdrawal and involuntary withdrawal. A voluntary withdrawal is when an individual withdraws their own application, while an involuntary withdrawal is when the state terminates an application due to ineligibility or other criteria. In order to withdraw an application, individuals must submit a signed and dated Withdrawal of Application for Services form to their local Alaska Department of Health and Social Services office.

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IMPORTANT NOTICE - This is a request to withdraw your application. If we approve it, the decision we made on your application will have no legal effect.Click "Submit an Official Withdrawal Request" link. If you are withdrawing for medical reasons, you may submit documentation for a medical withdrawal and consideration for a full or partial refund. Note: At each step along this process, the option to cancel your request to withdraw has been available. A Complete Withdrawal request can be completed online through the link below. Students who must leave during a current semester must officially withdraw (all classes) through the Department of Student Support and Transitions. Complete an Administrative Withdrawal Form - Please click here to access, fill out, and sign the form electronically. For example, you may be eligible to apply for a leave of absence (LOA) if you plan to return to the University. Member Services toll free at 888-320-7377 for the AP withdrawal application.

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Alaska Withdrawal of Application for Services