Online and Distance Ed - Distance Education Course Total Withdrawal Form

Use this form if you are withdrawing from your last or only online and distance education course.

Drop/Withdrawal Process: View the refund schedule

After you click 'Submit,'' please print the next page for your records.

Items with an * indicate a required field.
Student Information
First Name *
Middle Initial *
Last Name *
Address Line 1 *
City *
State *
Zip *
Phone *
Email *
Please submit your Ball State email address only. Confirmation emails will only be sent to your Ball State email account. We can no longer send drop/withdrawal confirmation emails to personal email accounts.
Course Information
Term *
Course #1 *
Course Delivery Method
Course #2
Course Delivery Method
Are you a Miller's Merry Manor or TLC employee? *  Yes
Why are you withdrawing from your courses? (Check all that apply)  Academic
  Administrative Disciplinary
  Church Mission
  Administrative Adjustment
  Course Situation
  Family Situation
  Foreign Aid Service
  Instructor Situation
  Medical Reasons
  Attend Other Institution
  Other (please explain below)
  Permanent Medical Condition
  Technical Situation
If you answered 'other,' please explain.
Are you planning on enrolling in the next semester? *  Yes

After you submit this form, please print the following page for your records. Once the drop or withdrawal has been processed you will be sent a confirmation email to your Ball Sate e-mail account.