Non-Returning Student Notification Form

Non-Returning Student Notification Form
This form is for students who do not plan to enroll at Lipscomb University for a future semester.

Submitting this form notifies the university of your intent not to return.

This form does not withdraw you from current courses.
If you are currently enrolled and want to withdraw from this semester, please complete the Withdrawal from the University Form instead.
Student Name

First NameLast Name
Student L#
Lipscomb Email Address
example@mail.lipscomb.edu
Secondary Email Address
example@example.com
Student Mobile Phone Number
Please provide a phone number where we can contact you if follow-up is needed.Format: (000) 000-0000.
Current Academic Level
Please confirm your intent:
Returning later? You may qualify for an Official Leave of Absence.
- Want to explore it? Do not submit this form. Review the policy HERE and contact academicsuccesscenter@lipscomb.edu.
- Not pursuing it? Continue with this form.
Please indicate the semester and year of anticipated return:
ex: Fall 2028
If other, please explain

Before Submitting This Form

Please discuss how a lapse in enrollment can affect aid, scholarships, etc. with the office listed below.

FinancialAid@lipscomb.edu

Before Submitting This Form

Please discuss any remaining balance on your student account with the office listed below.

BusinessOffice@lipscomb.edu

Acknowledgment Statements
Please read each item and sign below, indicating that you understand the following information:
Signature
Please note: Your form is not submitted until you select "Submit". If you are not ready to submit, select "Save Progress" to return at a later time.
Should be Empty:

Acknowledgment Statements