Semester Withdrawing: FALL 20 WINTER 20 SPRING 20 SUMMER 20
Student ID#: Name:
Last First
College Email Address: Primary Phone:
Please refer to the Academic Calendar for the nal date to withdraw from courses.
Note: A (W) grade will appear on the ocial transcript for courses from which a student withdraws.
No forms will be accepted after the deadline. Failure to properly withdraw from a course may result in a failing grade.
1. Speak to your Professor (Optional, but strongly recommended).
2. A signature from your Counselor, Faculty Advisor, or Professor is required to withdraw from one or more courses.
If you are taking an online course, we will accept an email from your instructor or advisor emailed together with this form.
3. Are you a Veteran? If YES, meet with your Veterans representative prior to withdrawing. Benets may be aected by your withdrawal.
4. Are you receiving Financial Aid?
• If YES, withdrawing from courses may aect your nancial aid and a signature from a Financial Aid Representative is required
prior to withdrawing from one or more courses.
• If NO, only a signature from a Counselor, Faculty Advisor, or Professor is required to withdraw from one or more courses.
Tunxis Community College
Completed form (signed and dated) must be submitted to the Registrar's Oce.
Tunxis Community College • 271 Scott Swamp Road • Farmington, CT • 860.773.1300 •
REFUND POLICY: Refunds are NOT granted for withdrawals.
By signing below, I acknowledge and understand that I am withdrawing from course(s) and I assume nancial responsibility according
to the student refund policy.
Student Signature: Date:
Withdrawal Reason Codes - Providing one or more reasons is optional.
JS: Job Schedule Conict CD: Course Content Diculty LI: Lack of Interest in Course
HM: Health/Medical Issues TM: Too Many Courses TD: Transportation Diculty
FO: Family Obligations/Childcare FD: Financial Diculties PR: Personal Reasons
MV: Moving Away/Relocating NN: Not Needed
Do you plan to return? YES Semester NO
Counselor/Faculty Advisor/ Financial Aid and/or Veterans Withdrawal
Course Title or Professor Signature Representative Signature Reason Code(s)
(Updated 1/22/2020)