C
Clovis Community
College
WITHDRAWAL
NOTICE
Spring
Summer
Fall
DATE
First Name
MI
Last Name
CRN
DEPT.
COURSE
NUMBER
SECTION
NUMBER
COURSE
TITLE
Reason for withdrawal: Plese select the main reason for the withdrawal below
In the space below, please write any comments, complaints, or suggestions you might have.
Student Signature Date
Financial Aid Signature (for students with any type of Financial Aid)
Date
Admissions and Records Date
Year: 20
Are you using Financial Aid? Yes No
Are you using Veteran’s Benefits? Yes No
(J) Lack of Finances
(K) Change of work/shift schedule
(L) TDY/Military Reassignment
(M) Other
(O) Heavy course load/homework
(P) Course too easy
(Q) Book not available
(R) Book too expensive
(B) Work
(C) Personal
(D) Medical
(E) Moving
(F) Transportation
(G) No babysitter
(H) Course too difficult
(I) Lack of Attendance
(S) Class schedule conflict
(T) Inadequately Advised
(U) Failing Class
(V) Family Issues/Emergency
(W) Advice of Instructor
(X) Incompatibility with instructor
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