COURSE SCHEDULE ADJUSTMENT FORM
SUNY Plattsburgh
Student’s Name (print): _________________________________ ID: _____________________________
Signature: ___________________________________________ Major: ___________________________
Local/Cell Phone Number: ______________________________ Email: ___________________________@plattsburgh.edu
Check One: □ Late Course Add □ Course Withdrawal □ Late Course Withdrawal
I will carry _______ credit hours this semester after the following course schedule adjustment.
International Students: Withdrawing from a course could impact your full-time enrollment status and/or compliance with online course
limitations based on U.S. immigration rules. Please consult with the Global Education Office (Kehoe 210) before submitting form.
Financial Aid: Withdrawing from this course could impact your financial aid in the current and/or future semesters. Due to complex
regulations, you should consult with the Financial Aid Office (FAO) before you withdraw. Initial one of the following:
_______ I opt not to, or do not need to, consult with the FAO _______ I have already consulted with the FAO
COURSE INFORMATION:
Course Reference Number (CRN): ___________________________ Semester/Year: ________________
Course Subject, Number, Section: __________________________________________________________
Instructor’s Name (print): __________________________________________________________________
LATE COURSE ADD: Beginning the second Monday of each semester, a $20 late course add fee is added automatically to the student’s bill
unless extenuating circumstances apply. (See Registration Guidebook.) List the reason for late course add below and explain how the
missing material will be made up. The following signatures are required:
Approve Deny Date
Indicate Approval in Email
□Instructor Signature: _________________________________ □ ________
Chairperson (of Course) Signature: _____________________
Indicate Approval in Email
□ □ ________
Dean (of Course) Signature: ___________________________
Indicate Approval in Email
□ □ ________
REASON:
Indicate Reason in Email
COURSE WITHDRAWAL: Courses may be dropped online without tuition liability or by completion of this form during the first seven days of
the semester. For fall and spring full-semester courses, commencing on the eighth calendar day of the semester and ending at midnight on the
Friday of the tenth week (or mid-point for courses offered less than a full semester) a student who submits a completed Course Schedule
Adjustment Form may withdraw from any class after consultation with his/her course instructor and advisor. Refer to winter and summer
registration guidebooks for withdrawal dates. A $20 course withdrawal fee applies. A W (withdrawal) will appear on the student’s transcript.
Last Date of Attendance (Required): __________________________________
Indicate Last Date of Attendance in Email
Instructor Signature: ________________________________________________ Date: _______
Indicate Approval in Email
Academic Advisor Signature: _________________________________________ Date: _______
Indicate Approval in Email
LATE COURSE WITHDRAWAL: Withdrawal is generally not allowed after the published withdrawal date. Appeal based on written
documentation of extenuating circumstances is possible. Failing grades are not justification for late course withdrawal. If approved a W
(withdrawal) will appear on the student’s transcript. Attach documentation of extenuating circumstances and obtain the dean’s signature. The
student should continue attending the course until a decision is made.
Approve Deny Date
Dean (of course) Signature: ______________________
Indicate Approval in Email
□ □ _______
Last Date of Attendance (Required): ______________________
Indicate Last Date of Attendance in Email
DATE OF REGISTRAR NOTIFICATION: ___________________ (Note: Refunds are based on the date this form is delivered to the
Registrar’s Office.)
Registrar Processed (initial/date) __________ Refund Notification to Student Accounts (date): _______
Verification of the approval and the processing of the student’s course adjustment is available by viewing the respective class roster on Banner
Web.
VPAA 04/2018 Email: registrar@plattsburgh.edu
