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Request to Withdraw from Program
Field Required *
(or other name(s) you may have used in the past.)
Date of Birth:
Your Mailing Address:
(for the next six months)
Your Email Address:
I hereby request to withdraw from the Vermont Law School Distance Learning Program.
(Please indicate which program you are withdrawing from.)
On what date did you last log into the LMS system?
Main Reason for Leaving Vermont Law School:
(Please select one option)
Cost of attending VLS
Availability of financial aid
Change in family situation
Program wasn't what I expected
(Please specify in Comments section below.)
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.
A good time to reach me:
My telephone number:
NB: Submitting this form acts as your signature on this document.
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