COURSE(S) TO BE WITHDRAWN
REASONS FOR WITHDRAWING
STUDENT SIGNATURE
Subject/Course #
Subject/Course #
Subject/Course #
Subject/Course #
Subject/Course #
Subject/Course #
Course Title
Course Title
Course Title
Course Title
Course Title
Course Title
Before returning this form, please complete the following confidential information.
List the course(s) from which you wish to be withdrawn:
Please sign and date to authorize withdrawal of course(s)
CRN #
CRN #
CRN #
CRN #
CRN #
CRN #
STUDENT INFORMATION
Registrar’s Office
Course Withdrawal
Prior to Two-Thirds into the Semester
First Name MI Last Name
Banner ID Number Are you receiving veteran’s benefits? Are you receiving financial aid?
September 2017/PR
FOR REGISTRAR OFFICE USE ONLY
Date Received _____/______/_______ Processed By _______________________________________________
Date _____/______/_______
Please complete this form, sign, date, and return it to the Registrar’s Office in SSC L157. Although the instructor’s signature is not required, it is recommended that you inform the
instructor of your decision.
Please check only one designation.
n
Too many hours outside employment
n
Course too difficult
n
Advising error
n
Illness
n
Too many courses
n
Paperwork error
n
Time conflict with job
n
Difficulty with teacher
n
Other
n
Yes
n
No
n
Yes
n
No
Note: Grades for courses from which a student withdraws during the first two-thirds of the semester will be recorded as “W” (withdrawn) at the end of the semester. After two-thirds of the
regular schedule, you must fill out an Instructor Approval Course Withdrawal. The form must be signed by the student and the instructor.
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2.
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6.
Student Signature
Date
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