Fillable Add / Drop / Total Withdrawal Form (Lehigh Carbon Community College)

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Add / Drop / Total Withdrawal Form (Lehigh Carbon Community College)

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Office of Registration/Student Records Use Only:
Is this a Total Withdrawal? Yes No
(If yes, update student status.)
Date Processed in Banner Initials
LEHIGH CARBON COMMUNITY COLLEGE
4525 Education Park Drive
Schnecksville, PA 18078-2502
Phone: 610-799-1171
Fax: 610-799-1173
Add / Drop / Total Withdrawal Form
SECTION 1: Student and Semester Information
Use this form ONLY when making changes to your class schedule. Complete one form for each semester of registration (Summer I and Summer II may be combined on one form).
Fall Winter Spring Summer
Reason for Total Withdrawal (Skip this item when only adding classes.):
Academic (i.e. transferring, course load, academic suspension, etc.)
Financial (i.e. lack of funds, financial aid insufficient, not eligible, etc.)
Health (i.e. illness, accident, hospitalization, etc.)
Military (i.e. joined the service, called to active duty)
Work Related (i.e. relocation, new job, shift change, etc.)
Other/Personal
Year
Student ID No. OR Social Security No. Phone No.
print Last Name First Name MI
SECTION 2: Schedule/Class Change
Dropping classes may affect your financial aid and veterans benefits. *AU – No credits or grade earned.
To register as an audit, write
AU in the appropriate box.
TO BE COMPLETED BY INSTRUCTOR ONLY
CRN # Subject Course # Section # Course Description AU* Cr. Instructor's Signature
Choose
Grade
D
R
O
P
W
W
W
W
W
W
A
D
D
W
W
W
W
W
W
Student Signature Date Advisor Signature Date
Advisor Name (PLEASE PRINT)
Return the completed form to the Office of Registration/Student Records at LCCC Main campus or any LCCC site location. The form will be processed on the day all required information is received or
postmarked by the U.S. Postal Service. If any required information or authorization is missing, the form may be returned unprocessed.
Total Credit Hours
I certify by signing below that the information is complete and accurate and I understand the
college refund/withdrawal policies.
White Copy = Registration Office
Yellow Copy = Student
PERM33C-ii (11/16/17)
SECTION 1 – Student and Term Information
Use this form when making changes to your class schedule. This includes withdrawal from all classes, which constitutes an official Total Withdrawal from the semester
indicated in Section 1. Complete one form for each semester of registration; Summer I and Summer II may be combined on one form. Semester refund dates are
available at www.lccc.edu, Current Students; Registration/Student Records; Withdrawal Policy and Procedures.
SECTION 2 – Schedule/Class Change
By signing and dating this form, the student (you) understands that they are agreeing to "abide by the policies and procedures set forth by LCCC. If the student
decides to discontinue enrollment in any of the classes added to their schedule, they must provide a signed written request immediately, to notify the Office of
Registration/Student Records. The student takes full responsibility for the outcome of the classes added to their schedule."
A
dding a Class
• Tuition is due at the time of registration when adding classes after the tuition due date.
Drop or Withdrawal from a Class
• From any or all credit classes:
Weeks 1 to 5 ........................... Automatic “W” grade assigned
Weeks 6 to 10 ......................... “W” or “Y” grades to be assigned by instructor with a signature or through LCCC email. Total withdrawals from all classes are accepted.
Week 11 to end of semester ...... No student-initiated withdrawals for individual classes. "W,” “Y,” “F,” or “I” grades to be assigned by the instructor. Total
Withdrawals from all classes are not accepted.
Official Total Withdrawal requires a written request with signature from the student by fax 610-799-1173, mail, or in person. The effective date of the
withdrawal is the date when the request is received in the Office of Registration/Student Records. Students may be reported for nonattendance by the
instructor. Students not attending who do not officially withdraw may receive a final grade of “F”.
Total Withdrawals with Financial Aid?
• Both the Office of Financial Aid and the Office of Registration/Student Records must be notified in writing of the student’s intent to withdraw.
If a student receives any type of financial aid (grants, scholarships, and loans) and officially withdraws from classes before the ninth week of class (60% of t
he
s
emester), the student’s financial aid will be prorated according to the U.S. Department of Education’s Federal Refund Policy. A student who falls under this
policy will have the appropriate percentage of his or her financial aid returned to the appropriate fund and is responsible to pay any balance remaining on th
e
ac
count as a result of this calculation. If a student does not attend class and does not officially withdraw, all charges will be billed to the student and
financial aid will be cancelled.
Office of Registration/Student Records—610-799-1171
Office of Financial Aid—610-799-1133
Return the completed Add/Drop/Total Withdrawal Form to the Office of Registration/Student Records at the LCCC Main campus or any LCCC site
location. The form will be processed on the day all required information is received by Office of Registration/Student Records or postmarked by the
U.S. Postal Service. If any required information or authorization is missing, the form may be returned unprocessed.
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Add Drop Total Withdrawal Form (Lehigh Carbon Community College)

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Completed 4 February 2021

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