Information must be printed or typed in black or blue ink. (Penciled forms will not be accepted.)
Updated November 2014 SSC
Student Name: __________________________________________________ ECC ID: __________________________________
The following changes in enrollment are requested for Semester: □Fall □Spring □Summer Academic year: _________________
Signature of Instructor (may be required for enrollment) Date
Signature of Instructor (required weeks 5 - 16)
Number of credit hours for the indicated semester following this action:
This document must be submitted for action to be processed. Student understands changes in enrollment may affect one or more of the following:
● Scholarship, federal grant status, or availability of other financial aid
● Corequisite or prerequisite status for other courses
● Program length
● Private health insurance
● Other enrollment-based status either contracted with East Central College or a third party.
Tuition and fee refund when dropping 16 week Fall/Spring courses:
● Week 1 = 100% ● Week 2 = 75% ● Week 3 = 50% ● Week 4 and following = no refund.
NOTE: Courses less than 16 weeks in duration are refunded at a prorated basis.
Student signature Date Advisor signature Date
Student understands failure to submit this form in a timely manner may result in an
administrative withdrawal or failing grade.
Advisor signature indicates only that student has been made aware of effects this petition
may have on his/her ECC academic program.