Spring 2020

Withdrawal Form

Please read the form below carefully and submit it should you have decided to return home and therefore withdraw from the Umbra Institute’s Spring 2020 semester due to the ongoing presence of COVID-19 in Italy. Please note that you will be contacted by Umbra staff upon submitting this form and that students must submit the form on their own behalf.

Students have two options:

Withdraw completely: Depart from Italy and not continue any courses (Option 1 on the form below);
Withdraw from on-site programming and continue with some or all of my courses remotely to received a final grade and academic credit (Option 2 on the form below).

IMPORTANT: You must communicate with your home school to understand how either option may impact your academic standing or financial aid. *special cases: If students decide to remain in Italy, and we strongly advise against it, please make an appointment with the academic director to discuss options.

Your Full Legal Name*
First Middle Last
What college or university do you attend in the U.S.?*
Email*
U.S. Phone Number*
Withdrawal Date*
Please specify the date on which you plan to vacate your Umbra apartment and return to the United States.
Date Format: MM slash DD slash YYYY
I understand that by choosing one of the withdrawal options below, I am agreeing to the following conditions:
- I am responsible for any costs associated with leaving (return flight, baggage check, etc.).
- I understand that there is no guarantee that I will not be exposed to the virus while traveling to return to the United States and that my health will not be the responsibility of the Umbra Institute upon departing the city.
- I will not receive any refund from the program for my withdrawal, with the exception of site visit fees for academic excursions I can no longer attend (limitations may apply to students who's home institutions paid the fees on their behalf).
- I will vacate student housing on the date of my withdrawal (specified above).
- I understand that with the exception of the academic program, the Institute will no longer provide any non-academic services once I withdraw from the program.
- If I choose to also withdraw from any courses I understand that it is my responsibility to communicate with my school and financial aid office to understand how my decision could impact my degree progress and financial aid.
In selecting Option 1 below, I understand and agree that I am:
- forfeiting receipt of grades for this semester and my home institution will be notified of my withdrawal for all courses.
- not going to be given the opportunity to opt back into my courses after my withdrawal.
In selecting Option 2 below, I understand and agree that:
- It is my responsibility to obtain any necessary approval from my home university to take some or all of my courses remotely; I accept any academic or financial consequences according to the policies of my home university;
- I will still be subject to the academic policies of the Institute;
- I must complete all assignments and course requirements requested by my professors in order to obtain a final grade and Umbra transcript, and that failure to do so may impact my grade;
- I understand that some assignments in the original syllabus may need to be adapted for remote study;
- I further understand that once I withdraw, a grade of W is not an option for course(s) I choose to continue remotely and for which I will receive a final grade.
Due to the Situation of COVID-19's presence in Italy, by submitting this form I am agreeing to withdraw from the Umbra Institute's on-site Spring 2020 semester programming through:
Withdrawal Option Selection*
- Option 1: Withdraw fully from the program and request a W for all courses on my transcript and accept any academic or financial consequences according to the policies of my home campus.
- Option 2: Complete some or all of my current courses remotely (via email/online) and according to the policies and directives provided to me by the Umbra Institute's staff and faculty.
Home School Permission*
I have consulted with my home institution and they have approved my withdrawal.
- Yes
Please type in the full name of the courses in which you would like TO REMAIN ENROLLED:*
Please type in the full name of the courses from which you would like to WITHDRAW COMPLETELY:*
Electronic Signature*
By signing my name and submitting this form, I agree to all of the withdrawal terms sited above and confirm that I am the student named in this submission submitting on my own behalf.
First Middle Last
Today's Date*
Date Format: MM slash DD slash YYYY
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Withdrawal Form – Spring 2020

Spring 2020

Withdrawal Form

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