Program Withdrawal Form

Students who are accepted into a graduate program and wish to withdraw must formally declare their intentions with Graduate Professional Studies by completing the following Program Withdrawal Form.

Should a withdrawn student decide at a future point to continue in their program, it may be necessary for the student to re-apply for admission. In this case there is no guarantee that previously completed courses will be applicable to current program requirements. GPS strongly recommends that students contact their student advisor with any questions or concerns.

Student Information

First Name

Last Name

Brandeis Email Address

Preferred Email Address

Student ID

Note: Your Student ID is required in order to confirm your student status. Student IDs can be found by accessing Workday and viewing the "Student Information" section in the "Summary" on your student profile.

Withdrawal Information

Program

Reason for Withdrawal

I understand that this form is singularly for the purpose of withdrawing from my Brandeis Online/GPS program. I understand that I must submit the course drop form to drop any courses I may be taking currently.

If you are not a Brandeis Online or GPS student, do not continue -- please contact your student advisor for steps on withdrawing from your program.

I understand

Financial aid/balance acknowledgment: I understand that depending on when I submit my proposal to withdraw from my program, I agree to pay any balance on my account that is a result of my request. I agree that if my financial aid is dispensed and I receive a refund of any kind I am responsible for paying back the university any of these funds.

If I am currently under a payment plan, I understand I am still responsible for any prorated tuition that I will be assessed depending on the fee assessment schedule.

A copy of the Financial Responsibility Agreement can be found here.

I understand and agree to comply with the Financial Responsibility Agreement

Program Withdrawal Form

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