High School Counselor/Representative Signature Date
Student signature Date
Parent Signature Date
Dual Credit Student Drop Form
Semester for Enrollment:
_________________________________________ _______________ __________________
First Name Middle Initial High School
UT Tyler Student ID
• The student will be enrolling in college credit course(s) and a letter grade will be recorded on his/her permanent college
• All registration deadlines, including adding, dropping, and withdrawing from coursework follow the official University of Texas at
Tyler Academic Calendar.
• All payment deadlines and refund schedules follow the official University of Texas at Tyler Academic Calendar and Refund
• I assume ALL responsibility for successfully completing my coursework, including directly working/communicating with my
instructors and The University of Texas at Tyler regarding grades, attendance, and/or behavioral issues.
• I am responsible for dropping or withdrawing. I understand that I must talk with my counselor and then submit required Add/Drop
or Withdrawal Form to the Dual Credit Coordinator.
• Any student who began college for the first time as a freshman in Fall 2007 or thereafter may not drop more than six courses
during their entire undergraduate career. This includes courses dropped at another 2-year or 4-year Texas public college or
university. For purposes of this rule, a dropped course is any course that is dropped after the published Census Date.
• Exceptions to the 6-Drop Rule, and the required documentation students must submit to claim each, are listed on the Office of
the Registrar's website.
Office Use Only
Course Title Course Number Section Number
By signing this form I confirm that I have read and understood the above-listed responsibilities and give consent to drop dual credit courses.
Dual Credit Coordinator Signature