Request for Withdrawal from Kentucky Wesleyan College Name* First Last Student ID Number*Enter your KWC Student ID Number. The ID Number can be found on your Student ID or it is located on the homepage of your Student Portal. Please include all leading zeroes.Your Home Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Your Cell Phone Number*Your Email Address*Please enter a non-KWC email address Enter Email Confirm Email Please choose one of the options below* Withdraw Leave of Absence Withdraw indicates that you do not plan on returning to KWC. Leave of Absence indicates that you do plan on returning to KWC.Reason for Leave* Medical Military Other Required Documentation*For a medical Leave of Absence (LOA) attach documentation from your physician. For a military LOA attach a copy of your current orders. You may attach up to five files. Allowed file types are: jpg, jpeg, gif, png, pdf, doc. The maximum file size allowed is 50 MbAccepted file types: jpg, jpeg, gif, png, pdf, doc, Max. file size: 50 MB.I plan to return to Kentucky Wesleyan* Fall Spring Summer * 2020 2021 2022 2023 2024 2025 My withdraw or leave of absence date will be* immediately at the end of the current semester I am currently on probation*Probation can include any academic, social, financial aid, disciplinary, or other types of probation. YES NO Please list the probation(s)*The last date you attended any class at KWC* MM slash DD slash YYYY