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VA/Military Benefits Withdrawal Notification

Withdraw Notification Form

Personal Information

Withdraw

Choose your preferred method to start the Complete Withdrawal process.

Complete Withdrawal online
Complete Withdrawal pdf

By submitting this form, I acknowledge the following:

  1. I am responsible for the payment of my tuition and fees regardless of VA benefits received.
  2. The VA will not pay for more than 100% of tuition. If you are receiving a Tuition Waiver, Tuition specific scholarships, or any other aid specifically earmarked for Tuition, that corresponding amount will not be submitted for payment to the VA.
  3. The only registered classes that can be certified are those that fall within my degree plan.
  4. It is my responsibility to notify the Veterans Coordinator if I add or drop a class. (including block classes)
  5. Classes can be purged for non-payment of tuition if I have an outstanding balance with Dixie State University
  6. I am also giving permission to the DSU Veteran and Military Service staff to share personal information (i.e. grades, tuition, etc) with the following agencies: Department of Veteran Affairs (VA), Department of Defense (DOD) and the Utah Department of Military and
    Veteran Affairs.
Choose your preferred method to start the Complete Withdrawal process.

Complete Withdrawal online
Complete Withdrawal pdf

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