Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code United States Country Last Four Digits of Your Social Security Number*Date of birth* MM slash DD slash YYYY Phone*Are you willing to receive text messages at this number?NoYesEmail* Reason for withdrawal:Did you receive a Direct Student Loan during your enrollment period? Yes No If Yes: Exit Loan Counseling is required when you drop from the program. This type of loan counseling guides you through the repayment process and ensures you understand your responsibilities. The Financial Aid Office will send you a packet of materials when you drop from the program which includes an Exit Loan Borrower's Guide from the U.S. Department of Education. You may also meet with the Financial Aid Office, a counselor will sit down with you and discuss your loan repayment obligations personally.I will complete Exit Loan Counseling:On-line at student loans.ed.govOn Campus, please call me for an appointmentCAPTCHANameThis field is for validation purposes and should be left unchanged.