San Diego Community College District
Class Adjustment Form
City Mesa Miramar
Fall Spring Summer Year:
Student Name:
(PRINT) Last First MI
Student ID Number: Service Person’s SSN/VA Number:
Counselor Signature: Date:
*Last Date of Attendance (LDA) is verified by the instructor’s records. If you remain on the class roster
beyond the withdrawal deadline the instructor must give you a letter grade even if you have stopped attending.
If you receive an “F” for any reason, including nonattendance, you may have to pay money back to the VA. Be
accurate as this information is reported to the Veterans Regional Office.
I CERTIFY THE FOREGOING INFORMATION IS TRUE, COMPLETE AND ACCURATE.
Student Signature: Date:
Distribution: Counseling; Veteran Affairs
SS/VETCLSADJ 11/2017
ADDED CLASSES DROPPED CLASSES
SUBJ CRSE# CRN# UNITS
START/
END
PAYABLE? SUBJ CRSE# CRN# UNITS LDA*
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