Virginia University of Lynchburg - Doctor of Healthcare Administration Program
Request for Withdrawal
At this student’s request, the Request for Withdrawal will be initiated with the submission of this form to the Office of the Registrar and the Dean of the School of Business and Professional Studies. The student is withdrawn from all courses based on the withdrawal date on the form, and tuition and fees are adjusted, if appropriate according to established policies.
Tuition adjustment, if applicable, is based on withdrawal date
Reason for Withdrawal: (check the appropriate responses) *
Signature *

University Approval Only
Registrar (Signature)
Dean, School of Business and Professional Studies (Signature)
Powered byFormsite