When you have completed the form, click the Submit button at the bottom of the form to transmit it to the College. Please print a copy of this form, for your records, BEFORE selecting the 'submit' button.

Students using financial aid who withdraw from one or more courses will be responsible for any financial charges caused by their withdrawal. Contact finaid@tesc.edu if you are unsure of the impact of your withdrawal.

I. Student Information

Student Name *
College ID Number *
Address *
City *
State*
Zip*
Telephone* Day: Eve:
Fax
E-mail Address*
Course Title*
Course Code*
Consulting Faculty Mentor*
Semester Originally Enrolled*

*
Required Fields


II.
Requests for course withdrawals must be on this form or in a letter to the Office of the Registrar containing all the information requested on this form. Withdrawal requests must be received in the Registrar's office prior to the last day of the term. Requests received later will be denied and a grade of "F" or "NC" will be assigned. If you withdraw from a course during the first three weeks of the semester, you may be eligible for a tuition refund as outlined below. Students who are enrolled in some special programs are not eligible for a refund. The postmark, fax date, or e-mail send date of the withdrawal request will be the official date of the withdrawal. Withdrawing from a course does not affect your status in the degree program in which you are enrolled nor does it withdrawal you from the College. Requests to withdrawal from the College must be sent as a separate request to registrar@tesc.edu.

GoArmyEd students must withdraw courses through the GoArmyEd portal. UMDNJ students must withdraw courses directly through UMDNJ. GoArmyEd and UMDNJ special population students cannot use this form to withdraw.

Refer to the textbook supplier's policy and procedures for return of course materials due to course withdrawal.

REASON FOR WITHDRAWAL REQUEST

III. Withdrawal Tuition Refund Schedule

Withdrawal requests must be postmarked, fax dated, or submitted via e-mail according to the following schedule for the corresponding refund:

Before the first day of the semester 100% of tuition refunded
Between the first and seventh day of the semester 75% of tuition refunded
Between the eighth and fourteenth day of the semester 50% of tuition refunded
Between the fifteenth and twenty-first day of the semester 25% of tuition refunded
After the twenty-first day of the semester No tuition will be refunded

Please note: The registration fee and late fee are nonrefundable. Tuition refunds will be processed within six weeks after receipt of withdrawal request.

If you do not wish to submit this form electronically, print and mail or fax the completed form to:

ATTN: Course Withdrawal
Office of the Registrar
Thomas Edison State College
101 West State St.
Trenton, NJ 08608-1101

Fax (609) 292-1657

If you mail or fax the form, please provide your signature.

Signature:_______________________________________

For Office Use Only:

[ ] Approved [ ] Denied

Date: _________ Auth: ____________________________