Course Withdrawal Form

This form is to be used for online (distance) courses only.
All highlighted fields are required.

Surname
First or Given Names
Student Number

Email
Phone Number

Mailing Address
City
Province
Postal/Zip Code

Course Code
Course Type
Starting Date
Percentage Completed

Reason for Withdrawal Request

Refund
Please process my refund (if any) by

Your withdrawal is effective the date this form is submitted

Contact Us

phone Phone: 902-585-1434
Toll-Free: 1-800-565-6568
Fax:  902-585-1057 
phone Rhodes Hall, Attn: Open Acadia
Acadia University
Wolfville, NS 
B4P 2R6
phone openacadia@acadiau.ca
Monday — Friday
8:30am to 4:30pm AST