Change in Status Form
Change in Status Form
Please complete this form if you would like to request a leave of absence or course withdrawal.
Name
Name
*
First
Last
Date
Date
*
/
MM
/
DD
YYYY
Type of Request
*
Withdrawal
Leave of Absence
First Term Enrolled at St. Joseph's College of Nursing
*
Course(s) Being Dropped:
*Please indicate whether you are with drawing from both theory and/or lab. For example, NSG110/111 or only NSG110.
*
Date Student Notified Staff or Faculty
Date Student Notified Staff or Faculty
*
/
MM
/
DD
YYYY
Faculty or Staff Member Student Notified:
*
Reason for Withdrawal
*
By initialing below, I understand that it is my responsibility to communicate with the Registrar/Bursar Office and how this course withdrawal will impact my current and future standing in the program.
*
Maximum of
2
characters allowed.
Currently Entered:
0
characters.
By initially below, I understand that I have five years to complete the St. Joseph's College of Nursing program starting from the first term enrolled.
*
Maximum of
2
characters allowed.
Currently Entered:
0
characters.
By initialing below,
• I understand the financial aid office may need to recalculate my current financial aid and process a return of funds.
• I understand any recalculation could create a balance and am financially responsible for any balances.
• I understand my GPA will be reviewed for Financial Aid Satisfactory Progress.
• I understand I need to complete Federal Exit Loan Counseling via studentloans.gov if I borrowed student loans while attending SJCON.
• I understand my enrollment status will be updated via the National Student Loan Database and if I have borrowed federal loans they will go into repayment after a six-month grace period.
*
Maximum of
2
characters allowed.
Currently Entered:
0
characters.
By initialing below, I understand that if I would like to return to the program there is a process dependent on the status of my withdrawal. To return based on a withdrawal passing, I will need to submit a request to the Registrar/Bursar Office. To return based on a withdrawal failure, I will need to complete the Reinstatement Form.
*
Maximum of
2
characters allowed.
Currently Entered:
0
characters.
Email for Confirmation of Completed Form
*