6004 S County Rd G P.O. Box 5009 Janesville, WI 53547-5009
(608) 757-7660 registration@blackhawk.edu • blackhawk.edu
Last Revised: 8/31/2018 1
Course Add / Drop / Withdrawal Form
PERSONAL INFORMATION
Student Name
BTC Student ID Number
Program
Date
Mailing Address
City
State
Zip Code
Please check this box if your address or phone number needs to be updated
COURSE(S) TO ADD:
CRN
CRN
Course Name
COURSE(S) TO DROP / WITHDRAW FROM:
Note: Withdrawing may have consequences. Please work with Advising and Financial Aid.
CRN
Course Name
Refund %
CRN
Course Name
Refund %
STUDENT EXPLANATION FOR SCHEDULE CHANGE:
Personal
Financial
Academic
Student Signature
Date
Advisor Signature
Date
Financial Aid Signature
Date
FACULTY EXPLANATION FOR SCHEDLE CHANGE (IF NEEDED):
Override Capacity
Late Add
Prerequisite / Test Score Error
Time Conflict
Closed Section
Exceeds Credits
Faculty Signature (if needed)
Date
RETURN COMPLETED FORM TO EXPRESS SERVICES
FOR REGISTRATION OFFICE USE ONLY
Signature
Date