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You must prepare a typed personal statement which addresses the extenuating circumstances that occurred and the reason why you are seeking a late withdrawal. 4. The certificate of withdrawal revokes the authority of the registered agent for the entity in this state to accept service of process.Items 1 - 6 — Submit the completed form in duplicate along with the filing fee and appropriate certificate of account status. Signature. Date. Step 3: Complete the Personal Statement. Fill out a Withdrawal Request Form explaining the specific request and reasons. Please review and complete each section of the petition, and be sure to upload your statement of withdrawal and supporting documentation on the last page. Complete the Late Withdrawal Request Form. Current students withdrawing from the university or needing to file for a late schedule adjustment should fill out the form. If approved, a late drop will result in a full refund of tuition fees and the complete removal of the course from your academic record. Mandatory statement.