Administrative Withdrawal Form
To: Registrar’s Office
From: _________________________
Academic Term: ________________
Date: _________________________
I am requesting that the following student be administratively withdrawn from the course listed below.
___________________________ ___________________________________________
Course Reference Number (CRN) Course Subject Number and Title
___________________________ ___________________________________________
Student ID number Student Name
I have worked with Student Affairs and the College Dean on the Administrative Withdrawal of this
student from my class.
___________________________________
Instructor’s Signature
___________________________________ _______________________________________
Student Affairs’ Signature College Dean or Designee Signature
Instructions:
An instructor may administratively withdraw a student from a course when there is justification for such
action as determined in consultation with student affairs, the Registrar’s Office and college Dean. For
students who have not attended class the first week please follow the No-Show Drop process.
In the case where a student is being removed from all EOU courses for a term, the CRN's can all be
added in the CRN section and the course subjects and numbers can be added without course titles. The
instructors do not need to sign the form in this situation.
Updated Dec 2018
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click to sign
signature
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click to sign
signature
click to edit
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