Banner Image
Back to Distance Learning Forms

Request to Withdraw from Program

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-VLS)

I hereby request to withdraw from the Vermont Law School Distance Learning Program. *     LLM    Masters
(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
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:

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