Online and Distance Education
Course Total Withdrawal Form

Contact Information

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.

Name*
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

Include course prefix and number
Include course prefix and number
Are you a Miller's Merry Manor or TLC employee?*
Why are you withdrawing from your courses? (Check all that apply)
Are you planning on enrolling in the next semester?*

Confirm Your Request for Withdrawl

Name: {$29642613 Name}

Address  {$29642622 Address}

Phone:  {$29642656 Phone}

Email:  {$29642657 Email}

Term:  {$29643410 Term}

Course One:  {$29643437 Course One}

Course one delivery method:  {$29643531 Course One Delivery Method}

Course Two:  {$29643547 Course Two}

Course two delivery method {$29643544 Course Two Delivery Method}

Miller's Merry Manor or TLC Employee:  {$29643577 Are you a Miller's Merry Manor or TLC employee?}

Why are you withdrawing:  {$29643581 Why are you withdrawing from your courses?...}

Are you planning on enrolling next year:  {$29643612 Are you planning on enrolling in the next...}