Study Abroad Withdrawal Form

Please discuss your intent to withdraw with your study abroad coordinator prior to submitting this form. Once your decision is final, submit the form below to withdraw from your study abroad program. By completing this form and clicking on the submit button below, you acknowledge that your withdrawal from your study abroad program is final and irreversible.

Student Full Name

Student Email Address

Student ID

Study Abroad Program Name

Study Abroad Term

Study Abroad Year

Reason for Withdrawal

Other

Medical

By choosing ‘Medical’, you will be required to submit a Medical Withdrawal Healthcare Provider Verification form. This form should be completed and signed by you and your healthcare provider and emailed to Lindsay Downs (Associate Director, Study Abroad) at lmdowns@arizona.edu.

Read and Understand

I understand that my decision to withdraw is final and irreversible AND I am subject to the Withdrawal Policy in my application.

Person Filling Out This Form (if other than the student)

Proxy Signature (if you are filling out this form for someone else)

I attest that the student above is presently incapacitated/incapable of completing this form. I understand that I must provide verification of the incapacity that renders the above named student incapable of completing this withdrawal without assistance. If I have chosen “medical” as the reason for withdrawal, I understand that I may be required to submit official documentation containing the information outlined above.**

**If applicable, one document can be submitted to satisfy both requirements delineated above.