NY Campus: The clinic will reopen on Monday, July 22nd at 9am. All clinic shifts will be on the 19th floor.

Petition for Withdrawal Form

Petition for Withdrawal Form

  1. Instructions

    We recommend meeting with the advising team for guidance, before completing this form.

    A student who petitions to withdraw from the PCHS intends to terminate their enrollment with the institution and will not attend/register for the term(s) indicated. If your petition to withdraw occurs after the official add/drop period, all fees are non-refundable and tuition charges will apply to courses as per the college’s course add/drop refund policy. Please see the catalog for details. Additionally, a student must complete exit loan counseling at PCHS Financial Aid.

  2. Student Information

    Please enter your information below.

  3. Required Information

    Please enter the required information below.

    Program (please select all that apply):


    Please select the reason for withdrawal (please select all that apply):

    Please select all that apply:

  4. Acknowledgements
    • Students who request to withdraw from PCHS will be dropped from all their courses.
    • Withdrawing may result in partial or full tuition and fees liability and/or a reduction or cancellation of your financial aid such as Excelsior, PELL, TAP, Stafford Loans, etc. It is recommended you consult with a Financial Aid officer prior to withdrawing to learn how your enrollment affects your awards.
    • Federal Aid may be adjusted based on the percentage of the semester completed, possibly resulting in a balance being owed to the College. Direct Loan borrowers must complete exit counseling with the Financial Aid Office or online at studentloans.gov.
    • If you have any outstanding balances, a hold will be placed on your account. Holds will prevent you from registering for future classes if you choose to petition to return at a future date.
    • Courses where less than 60% of the course hours have elapsed, will earn a grade of “W” or Withdrawal on their academic record with a prorated tuition charge.
    • Courses where 60% of the course hours have elapsed, will earn a grade of “WF” or Withdrawal Failure on their academic record with no refund of tuition. A grade of “WF” is calculated into the GPA.
    • The Registrar’s Office will process this request within 3 – 5 business days.
    • I have carefully considered this decision and wish to officially withdraw from the program.