] REJECTED IACAD-101

APPLICATION TO WITHDRAW FROM THE COLLEGE

SECTION A : STUDENT'S INFORMATION

NAME : NI/() ,f'f/111.V#'tN /£ /ff/(!,I( fl (!,} ll.l'I ):/t-t/

MATRICNO. : OllJ 1.10 F/ H/PNO. : Ollu<l I fD6 rct
PARENTS/ GUARDIAN HIP NO. 01v-3sVIJ-t!' EMAIL
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PERMANENT ADDRESS : .,.,- C>J o t..o?"R crNll#e ft.N()l'fR./
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SECTIONB : APPLICATION INFORMATION

SEMESTER APPLIED FOR

LEAVE: SEMESTER I ACADEMIC SESSION lD~
REASON FOR WITHDRAW: Financial Reasons IFamily Problems ilJIPtnonal Reasons I
Medical Reasons

Otbtn
IEmployment ( (Get other offer
J

SECTION C : DECLARATION BY THE STUDENT ,SIGNA¥,JRE / DATE

I agree that I have to settle any remaining fees (if any) immediately before leaving. I hereby return my Matric Card for UC
processing action. I also understand that the decision made consequent to this application fonn will be final.
~-(1&·1~-)1)
SECTION D - RECOMMENDATION AND APPROVAL SIGNATURE & STAMP/ DATE
Dean of School Reason for Recommendation:

Student Affairs and Development Reason for Recommendation:

Division

Library Reason for Recommendation:

Students Finance Department Reason for Recommendation:

Markednc & Business Development Reason for Recommendation:

Division

Academic Division Remarks: