Print form, complete, and send to:
Missouri State University
Registration Center, 320 Carrington Hall
901 S. National Avenue
Springfield, MO 65897

Or, completed form may be faxed to (417) 836-8776. If you fax your request please call 417-836-5520 to confirm your request was received.

Please review the Withdrawal Policies and Procedures information before completing this form. Do not complete this form unless you want to drop all of your classes. This is a withdraw from a semester it does not affect future enrollments.

Last Name:

First Name:

M.I.:

Student ID Number:

Date:

PERMANENT ADDRESS:

Street:

City State Zip:

Permanent Phone:

Semester and year of withdrawal:

Reason for withdrawal (optional):

Approximate last date of attendance :

I have read and understand the Withdrawal Policies and Procedures. I further understand that I will remain responsible for any and all debts incurred at Missouri State University.

Student Signature:

E-mail: