PREP Application for Withdrawal

Students submitting this application should ensure they have read and understood CPLED’s policies.

This form should be used to request a temporary or permanent withdrawal from PREP.

Name*
First Last
CPLED Student ID/Account Number*
To locate your CPLED Student ID/Account Number, please follow these steps: 1. Log into the CPLED Student Portal. 2. Navigate to your tuition fee invoice, where you will find your CPLED Student ID/Account Number listed.
Email*
Phone number*
I request to withdraw from my program with the effective date (YYYY-MM-DD):*
I request to withdraw for the following reasons: (optional)
I confirm that I have read and understood the requirements of this form and any relevant CPLED policies. I affirm that all the information and documentation provided in support of this application are accurate and true. I understand that CPLED may request further information and documentation from me in support of my application. For the purposes of verifying authenticity, I authorize CPLED to contact anyone who provided documentation submitted in support of this application, including but not limited to medical documentation.*
First & Last Name