DROP / WITHDRAWAL FORM
TRCC is committed to helping you achieve your academic goals; however, we realize that sometimes circumstances may occur that prevent
you from successfully completing your coursework as planned.
Student Name ______________________________________________________ Grad Year: _______________
TRCC Student ID Number @ _______________________________________
High School ____________________________________________________
(Ex: MAT*K137, BIO*K115)
COURSE TITLE TEACHER NAME
REASON FOR DROP / WITHDRAW
Student Signature: _____________________________________________________________________ Date: _______________________
I acknowledge and understand the college course withdrawal policies and authorize the processing of my request.
Parent or Guidance Counselor Signature: ___________________________________________________ Date: _______________________
Mail to: College Career Pathways, Three Rivers Community College, 574 New London Turnpike, Norwich, CT 06360 or Fax: 860/215-9914
COLLEGE CAREER PATHWAYS SECTION ONLY
Processed By: ______________________ Date: ______________________