Resignation Request

	Sam Houston State University
	A Member of The Texas State University System Office of the Registrar Huntsville, Texas 77341-2029	Office: (936) 294-1052 FAX: (936) 294-1737

RESIGNATION REQUEST

NOTE: Please review the Resignation Policies and Procedures page before completing this form. DO NOT complete this form unless you want to resign from ALL of your courses. TO RE-ENROLL AT SAM HOUSTON STATE UNIVERSITY YOU WILL NEED TO FILE A NEW APPLICATION FOR ADMISSION.

				Date:___________________
____________________________ SamID			___________________________ Last Name	_____________________ First Name	______ MI

Permanent Address:

_______________________________
Street _______________________________
City __________
State __________
Zip

Telephone Number: __________
Area Code __________________
Number

I have read and understand the Resignation Policies and Procedures. I further understand that I will remain responsible for any and all debts incurred at Sam Houston State University.

Student Signature: ______________________________________________________________________________

Indicate Semester in which you are resigning (ccyy):

Fall __________ Spring _________ Summer I ____________ Summer II ____________ Minimester ______________

ALL FINANCIAL OBLIGATIONS ARE THE RESPONSIBILITY OF THE STUDENT!! YOU MUST CLEAR YOUR ACCOUNT(S) WITH THE FOLLOWING DEPARTMENT(S) BEFORE RETURNING THIS FORM TO THE OFFICE OF THE REGISTRAR:

1: The Sam Center ______
Academic Bldg. IV, Room 210
(936) 294-444

4: Office of Residence Life _______
Report to Hall Director's Office
or
Main Office, Ave. I and 20th Street
(936) 294-1812

2: The Office of Student Financial Aid ______
Estill Bldg., Room 205
(936) 294-1724

5: Office of the Registrar ______
Estill Bldg., Room 331
(936) 294-1052

3: Office of Student Accounting ______
Administration Bldg., Room 202
(936) 294-1089

Processed by ___________________
Date __________________________

**NOTE: YOUR RESIGNATION IS EFFECTIVE THE DATE THIS REQUEST IS RECEIVED IN THE OFFICE OF THE REGISTRAR**

RESIGNATION REQUEST AGREEMENT

DO NOT complete this form if you have already taken any final exams this semester.

Date: _____________________

Student ID #: ___________________

Last Name: ______________________________ First Name: __________________________ Middle Initial: ____

Telephone Number: (______) __________________________ (______) __________________________

I have read and understand the Resignation Policies and Procedures. I further understand that I will remain responsible for any and all debt incurred at Sam Houston State University. In addition by signing this form I am stating that I have not taken any final exams during the semester in which I am resigning.

Student Signature: _________________________________________

Indicate Semester in which you are resigning (ccyy):

Fall _______________	Spring _____________
Mini _______________	Summer I __________
Ten Week __________	Summer II __________

Processed by _________________

Date ________________________

Resignation Policies and Procedures

The date the official resignation request is received by the Office of the Registrar shall be the date used in determining the refund of fees or the issuance of the "W" mark if resigning after the 12th/4th class day.

*Refunds: Refunds are made in accordance with the following schedules:

Fall and Spring Semesters
Before the 1st class day	100%-Less $15 matriculation fee
**1st class day through 5th class day	80%
6th class day through 10th class day	70%
11th class day through 15th class day	50%
16th class day through 20th class day	25%
Thereafter	No Refund

The above refund schedule assumes the student has paid his or her fees in full. A different schedule applies to the installment payment plan participants--the primary difference in the schedule being the requirement for the University to compute the refund based on the assumption that the full amount of tuition and fees have been collected. Therefore, it is possible, and probable, that a student in the installment plan could owe more tuition and fees than already collected by the University.

Summer Sessions
Before the 1st class day	100%-Less $15 matriculation fee
**1st class day through 3rd class day	80%
4th class day through 6th class day	50%
Thereafter	No Refund

PRO-RATA REFUND: Only applicable to all first-time students (including first-time transfer students) who received federal and/or state funds. This refund applies to fall, spring, and summer enrollment.

FINANCIAL AID CLEARANCE: A student who received financial aid, scholarships, or short-term loans for payment of tuition, fees, housing and/or dining must contact the Financial Aid Office immediately. Participation in an Exit Interview may be required.

RESIDENCE LIFE (HOUSING AND DINING): A student who resigns from the university is no longer an enrolled student AND MUST CHECK OUT OF THE RESIDENCE HALL/APARTMENT IMMEDIATELY. The student must report to the Hall Director's Office. Charges will be prorated according to the student's current contract(s) for these services.

VETERANS: The resignation status of a student who is receiving Veterans Benefits will be reported to VA by the Registrar's Office.

REFUNDS: Refunds will be issued by the Finance Division approximately seven (14) days after the date the resignation is received by the Registrar's Office or 30 days after the date of the last payment by check, whichever is later. To avoid the 30 day waiting period for checks, send a copy of both sides of the cancelled check to the Office of Student Accounting. Prior to issuing a refund, that office will deduct any outstanding financial obligations to the University from the refund amount. Refunds will be available to you based on the preference you have selected through BearkatOne.com

*Refund policies were established by Senate Bill No. 604 of the 65th Legislature and adopted by the Board of Regents, Texas State University System, in August of 1977.

**"1st class day" refers to the first class meeting day as designated in the appropriate Academic Calendar, not to an individual's first class meeting day.