Complete Withdrawal Form
13650 Apple Harvest Drive
Martinsburg, WV 25403
TEL: 304-260-4380
FAX: 304-260-4376
www.blueridgectc.edu
1. Complete withdrawals (withdrawal from ALL classes) may be eligible for partial tuition reimbursement. See
Academic Calendar for deadlines.
2. Partial Withdraws are required to be completed on Bridge. There are no refunds for partial withdrawals (i.e.
withdrawal from one or more, but not all classes).
3. Form must have all signatures before it will be processed.
4. A grade of W will be recorded on the students transcript.
5. Below full time (12 hours) may affect financial aid eligibility and dependent insurance coverage. Financial Aid
refunds will be based on the Last Day of Attendance submitted in Bridge by instructors.
6. This form, when completed, must be returned to the Welcome Desk before the deadline established in the academic
calendar.
7. The Complete Withdrawal becomes official once the Registrar's Office processes the request.
I understand that by signing this form, I am withdrawing from the classes above. I have read the information on
the back of this form regarding refunds, and I understand this policy. I have been made aware of any
consequences of withdrawing and how it may affect my financial aid and registration status.
Full Name: Major:
CRN SUB CRS NO SEC TITLE CREDITS
INSTRUCTOR
SIGNATURE
DATE OF LAST
ATTENDANCE
Signatures must be obtained
in order listed. You may get
faculty or staff's approval via
e-mail. Print the e-mail and
attach the approval to this
form.
updated 1/31/2018
Academic Difficulty
Other Reason (Please explain)
Financial Aid Signature:
Student Advocacy
Would you like someone from BRCTC to call and talk to with you concerning your withdraw?
YES NO
Future Educational Plans (Choose One)
I plan to return to BRCTC I plan to transfer to another institution I no longer plan to attend college
Were you satisfied with your BRCTC experience?
What college services did you utilize?
Accommodations
Expected Grad Date:SID:
Are you receiving Veteran Benefits?
NOYES
Student Services Signature:
Date:
Date:
Date:
Student Signature:
Financial Issues Family Responsibilities
Dissatisfied with classes Employment
Relocating
Health Issues
Military Duties
Please select the reason(s) for your withdrawal below.
If yes, please provide best phone number and time to call:
Which Student Services should BRCTC consider adding?
What may have been done to prevent you from withdrawing?
YES NO
Tutoring Computer Lab
Advising
IT Help Desk
BlackBoard Help Desk
