Any student who wishes to withdraw from a course for which they are duly enrolled must complete this form and submit it to KSI Registrar’s Office.  Students who separate from a/all course/s without a completed form will receive a failing grade.  If you are withdrawing from a course/s this form must be completed in its entirety.   

Students completing this form will receive a prorated refund based upon the refund policy of KSI.  *However, no student will be allowed to withdraw during the last two weeks of any semester.

Personal Information

Name(Required)
Current Address
List the Course Number and Title for course/s.
Withdrawal Confirmation(Required)
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For Office Use

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Provost
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Result
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