Advisor / Program Faculty
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
Financial Aid Representative Signature (Required) _________________________________________ R2T4
DROP/Withdrawal: Advisor/Instructor signature is required.
Are you transferring to another college/university? Yes No If yes, 2 year institution or 4 year institution
: Instructor signature is required on/after first day of classes.
Reason for Administrative Approval:
inistrative Approval _______________________________________ Date______________________
Student Signature Date
Semester Term/Year (Fall,Spring,Summer):
Alternate Contact Name & Number:
Are you dropping all courses? Yes
Reason for Drop/Withdrawal:
DROP/ADD OR WITHDRAWAL FORM