Cal Poly Scholars Program Departure Form
Are you a Cal Poly Scholar interested in leaving the program permanently or leaving Cal Poly's campus temporarily? Please complete the form below to help our team better support you through the process.
Cal Poly email
Please select your first academic year at Cal Poly.
Which option best describes your situation?
I plan to leave Cal Poly's campus temporarily (i.e. study abroad, co-op, medical leave), but I hope to continue participating in the Cal Poly Scholars program when I return.
I want to leave the Cal Poly Scholars program, but I plan to remain at Cal Poly.
I plan to leave Cal Poly permanently.
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