# Domestic Withdrawal Application

Are you registered in any Open Learning Courses?

| | |
|---|---|
| Type | PDF |
| Size | 203 KB |

[Open original PDF →](https://www.northerncollege.ca/uploads/2025/09/Withdrawal-Form.pdf)

Referenced from: [Withdrawal & Refund Information](/pages/registrar/withdrawals/)

## Document text

<!-- image -->

## Domestic Withdrawal Application

Student Name

Student #

Street

City

PO Box

Province

Country

Postal Code

Phone

Program

Campus

## Part A: Primary Information

## Part B: Address

## Part C: Reason for Withdrawal (check appropriate box)

- [ ] Financial Pressure

- [ ] Left to Attend Another School

- [ ] Personal

- [ ] Program Not Suitable

- [ ] Other (Please Specify)

- [ ] Health

- [ ] Program Related Difficulties

- [ ] Left to Take Job

Are you registered in any Open Learning Courses?

- [ ] Yes

- [ ] No

- [ ] No

- [ ] Yes

Do you wish to continue in these courses after withdrawal?

Advisor's Comments

Date

- [ ] No

- [ ] Yes

OSAP Student

## Part D: Returned Items

Laptop and any other

resources returned

- [ ] No

- [ ] Yes

Signature - Advisor

Signature - Coordinator/Director

Date

Coordinator's Comments

Declaration: I certify that I do not hold any article(s) that may be considered the property of Northern College.

Signature - Student

Date

Connected with a Financial Aid Officer

Verified L earning Resource Center

Signature - Student

Signature - Library Technician

- [x] N/A

Only required after Day 10 of the current semester.

Only required after Day 10 of the current semester.

---

<small>Source: [https://www.northerncollege.ca/uploads/2025/09/Withdrawal-Form.pdf](https://www.northerncollege.ca/uploads/2025/09/Withdrawal-Form.pdf)</small>