Permanent Withdrawal Form

Name*

First Last

Major*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

LCAD E-mail*

Non LCAD E-mail*

Cell Phone Number*

I AM REQUESTING A WITHDRAWAL FROM LCAD EFFECTIVE BEGINNING:*

I AM REQUESTING A WITHDRAWAL DUE TO:*

IF YOU ARE TRANSFERRING TO ANOTHER COLLEGE, WHICH COLLEGE(S) ARE YOU CONSIDERING?*

Agreement*

BY SUBMITTING THIS FORM, I UNDERSTAND THAT I AM WITHDRAWING FROM LCAD EFFECTIVE AS STATED ABOVE.

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