Drop Form
Submit Completed form through your student email to MJCESeForms@mjc.edu. If the form
is submitted through an alternate email please provide a copy of your picture ID and a “wet”
signature.
Today’s Date:
Student Information:
First Name: Middle Initial: Last Name:
Student ID: Birthdate: Phone Number:
Course Information:
Term/Year: Summer Fall Spring
Section # Course Name & Number Census Date Refund Date
1234 Eng-100 Oce Use Only Oce Use Only
By signing this form i agree to the following:
1. The Enrollment Services Oce will drop me immediately from the courses listed above.
2. I understand the drop(s) will not be processed if:
a. the “drop deadline” has passed for the course.
b. the “refund deadline” for the course has passed and I owe fees.
c. there are outstanding obligations or holds on my account.
Student Signature: Date:
Oce Use Only
Sta initials: Date: ID Veried:
Comments:
03/2020_SJB
MJC Enrollment Services • MJCESeForms@mjc.edu
click to sign
signature
click to edit
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