Updated 9/2018
Office Use Only
Initial
Date
CE / Front Desk
Advisor / Program Faculty
Admissions
Financial Aid
Student Retention
Registrar
Business Office
Registrar
Are you receiving financial aid, loans, scholarships and/or Veteran’s benefits this semester? Yes No
*If yes, you must check with Financial Aid to see how your financial aid is affected by the decrease in your total hours of
enrollment.
Financial Aid Representative Signature (Required) _________________________________________ R2T4
VA
DROP/Withdrawal: Advisor/Instructor signature is required.
Course / Section #
Course Name
Credit Hours
Effective Date
Are you transferring to another college/university? Yes No If yes, 2 year institution or 4 year institution
Advisor/Instructor Signature
ADD
: Instructor signature is required on/after first day of classes.
Course / Section #
Course Name
Credit Hours
Effective Date
Reason for Administrative Approval:
Adm
inistrative Approval _______________________________________ Date______________________
Student Signature Date
Last Name:
First Name:
ID #
Program:
Semester Term/Year (Fall,Spring,Summer):
Phone Number:
Email Address:
Alternate Contact Name & Number:
Are you dropping all courses? Yes
No
Reason for Drop/Withdrawal:
DROP/ADD OR WITHDRAWAL FORM
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