Official Withdrawal Form

Please fill out the following information and click the submit button. "*" indicates mandatory fields.

*Student Full Name (exactly as it appears on your Application form):
*Email
*Verify Email

SECURITY QUESTIONS

*City of residence from your Application form:

For the following 3 questions, do not enter the date directly into the box.
Please click on the calendar icon and click the right and left arrows to
go to the date you want to select, then click on that date.  The date will
automatically show in the window with the correct format.

*Date of Birth (use calendar):
*Date of your original Application (use calendar):
*Official Date Of Withdrawal from SLBC (use calendar):
*From what High School did you graduate?
(If you did not graduate from a High School, enter "GED" and the date you earned your GED.)

In the next box, please specify why you are withdrawing from SLBC.
If you do not want to specify "Why" then simply enter NONE in the box.

Reason for your withdrawal?

1000 characters remaining.

STUDENT'S DECLARATION FOLLOWS:

By submitting this form I am acknowledging that the information on it is correct
and that I am the person whose name appears in the Student Full Name
field of this document. Submission of this form is my acknowledgment
that I am officially withdrawing as a student from Salt Lake Bible
College and/or Salt Lake Baptist College.

Submission of this form by me is to be considered legally
the same as my signature on this document.