Course Withdrawal Form
NAME: Last: First: CFK ID:
Degree Seeking YES
Withdrawal Reason:
*Please select one.
Active Military/Duty
Withdraw Due to COVID-19
*If you chose "Other," please explain.
Course Prefix Course Number CRN
Semester Hours: Instructor Name:
* If there is a corresponding or paired lab with this lecture, please fill out a separate withdrawal form for the lab.
Please fill out the last date of attendance or last date of
activity, whichever is the later date.
Last Date of Attendance
Last Date of Activity
Before you withdraw from a course, you should be aware that course withdrawals:
*Will increase the cost of your education.
*May affect your financial aid status, such as repayment of a portion of aid and restrictions on future eligibility.
*May affect your transfer grade point average.
*May result in your having to pay the full cost of instruction fee to retake the course.
*May affect your anticipated graduation date.
*May result in your being denied access to limited access programs.
*May affect your immigration status if you are attending on a non-immigrant visa.
*Will result in your required repayment of course fees paid by a Bright Futures scholarship.
So, before you withdraw:
*Talk with your professor to discuss your progress in the course.
*Meet with Financial Aid Staff and/or an Academic Advisor to discuss how a withdrawal will affect the status of your financial aid
and your career and education plans.
Student Signature: ___________________________________________________ DATE:
Instructor Signature: __________________________________________________ DATE:
Instructors: Please e-mail the signed form from your College e-mail to Enrollment Services at
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