Please check the primary reason for withdrawal
Reason Code
Severe Illness 01
Provide Family Care 02
Death in Family 03
Active Duty 04
Change in Work Schedule 05
Trans
p
ortation
06
Financial reasons 07
Change of residence 08
Grade problem 09
Dissatisfied with instruction 10
Dissatisfied with course content 11
Other personal / family reasons 12
Other (Please Specify) 99
________________________________
_______________________________
Effective Fall 2007, documentation must
be provided for an excusable withdrawal
from a class or classes under Texas
Senate Bill 1231 guidelines. Students
who withdraw
without documentation will
be included in SB 1231 withdraw
General Information:
The With
draw
al Form is to be used after the census date (12
th
class day for long semester and 4
th
class day for summer
sessions) to withdraw from a class or withdraw from all classes at Galveston College. The withdrawal process is not
complete until the student has obtained all signatures and submitted the form to the Admissions Office.
Class Withdrawal Complete Withdrawal
Fall Spring Summer I Summer II 20______
Name: _______
Last First M.I.
Student ID: _____
____________________
I am receiving financial aid from Galveston College:
Yes No
Financial Aid initials_________________________
I am receiving Veterans Benefits: Yes No
Veteran Coordinator initials___________________
I am an International student: Yes No
International Student Specialist initials__________
I am an Athlete: Yes No
Coach initials _______________________________
REQUIRED:
All indebted
ness to the College must be satisfied with the College’s Business
Office prior to withdrawal. When all financial obligations are met, official
transcripts will be available upon request. The last day to completely withdraw
from school is noted in the printed class schedule and catalog available
online at www.gc.edu.
STUDENT:
DO NOT LEAVE YOUR WITHDRAWAL FORM IN ANY OFFICE. YOU ARE
RESPONSIBLE FOR COMPLETING AND RETURNING THE FORM TO THE
OFFICE OF ADMISSIONS
.
I acknowledge that I have been advised of SB 1231 (6 Drop Limitation)
Student’s initial ____________
Course Name & Number Call Number Instructor’s Name
The official withdrawal date will be the day this form is submitted to the Office of Admissions.
Student’s Signature: Date: ____________________________
Counsel
or/Advisor’s Signature_______________________________________ Date:_____________________________
Financial Aid Signature: ____ Date: _____________________________
Date Processed b
y Office of Admissions:
Revised: 05/11/2015
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