Vermont Law School
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Request to Withdraw from Online Learning Program


The Registrar's Office does not have the authority to grant withdrawals for Juris Doctor, MELP or LL.M. degree candidates. All requests must be approved by the Assistant Dean for Student Affairs and Diversity.
Your Name: *
Nickname:
(or other name(s) you may have used in the past.)
Date of Birth: *
(MM/DD/YYYY)
Your Mailing Address: *
(for the next six months)		 Street: City: State: Zip:
Your Email Address: *
(non-VLGS)

I hereby request to withdraw from the following Vermont Law and Graduate School Program(s). *
(Please indicate which program you are withdrawing from.)
JD      LLM     Masters      Certificate     
 
On what date did you last log into the LMS system or attend classes? *
 
Main Reason for Leaving Vermont Law and Graduate School: *
(Please select one option)		 Cost of attending VLGS
Health problems
Availability of financial aid
Change in family situation
Program wasn't what I expected
Other (Please specify in Comments section below.)

Comments:
Thank you for taking the time to fill out this questionnaire.
Please indicate if you would be willing to discuss your answers via telephone or email. *     Yes    No
A good time to reach me:
My telephone number:
Information Collection Disclosure:

The information you enter here is retained by VLGS for internal use, and may be submitted to third-party tools or entities for specific, related purposes such as payment processing or reporting. All data is collected and retained via secure protocols. Click here to read relevant policy information.
European Union residents, click here to request removal of your data from our systems.

Please check this box to indicate that you understand the data retention policy information.

NB: Submitting this form acts as your signature on this document.