Fillable COVID Withdrawal Attestation (Grand Canyon University)

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COVID Withdrawal Attestation (Grand Canyon University)

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P0312102020
COVID Withdrawal Attestation
StudentName:_________________________________GCUStudentNumber:___________________
I duly attest that I have notified my Student Services Counselor that I am withdrawing from Grand
Canyon University and will no longer be a student due to COVID-19 (a.k.a. Coronavirus, SARS -CoV-2).
Below is my reason COVID-19 is leading to the withdrawal from the University (allowable circumstances
include, but are not limited to, my illness or the illness of a family member, need to become a caregiver
or first responder, loss of childcare, economic hardship, inability to access WI-FI due to closed facilities,
or an increase in work hours as a result of the COVID-19 emergency):
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
StudentSignature:__________________________________________ Date:____________________
WARNING:
Intentionally providing false or misleading information on this form may subject you to federal
prosecution and penalties including fines, imprisonment, or both.
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COVID Withdrawal Attestation (Grand Canyon University)

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Completed 28 January 2021

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