Withdrawal Request Form

Participant Information

Please submit your 8-digit Lancaster University Student ID, your First Name, and Last Name in full.
You can access your LU email address and University ID information through Lancaster University's student portal (https://portal.lancaster.ac.uk). Where your name is visible on the top right of the page, press the drop-down arrow next to this and select 'my profile'.

Student ID

First Name

Last Name

Withdrawal Information

What year of study does this withdrawal request relate to?

Type of Request:

Please let us know the date you would ideally like your withdrawal to start? Please note that this date is not confirmed until it has been approved by Frontline.

Please let us know what is the primary reason you are withdrawing?

You selected 'Health reasons' for primary reason, please let us know what this relates to

If there is an additional reason why you're looking to withdraw, please select it here:

You selected 'Health reasons' for additional reason, please let us know what this relates to

Please use the following space to describe why you wish to withdraw from the programme of study. If you could include the following:

- Key facts and dates about why you want or need to withdraw

- What support provisions have you explored to date

- What measures and/or support provisions have already been explored

Please attach and include all relevant and supporting evidence that you wish to be considered as part and in support of your application.

Supporting Evidence

Declaration:

I confirm that all information completed on this form is honest and accurate to the best of my knowledge. I confirm that I have read and understood the policy associated with this request. That I fully understand the implications of my application and that if intercalation is granted that I agree to abide by the conditions of intercalation and by any other reasonable conditions specified/required.

Contact Information