15 10 A B
❏ Fall __ __ __ __
❏ Winter __ __ __ __
❏ Spring __ __ __ __
❏ Summer __ __ __ __
❏ WE __ __ __ __
❏ DROP/ADD
❏ WORKFORCE EDUCATION
Office Use:
Student’s Full Name:
Last First M.I.
Student’s Mailing Address:
Street & Number
City State Zip
Primary Phone
Check all that apply: ❏ NJ Stars ❏ School Counts! ❏ Financial Aid ❏ Other Scholarship
❏
I understand my decision to withdraw from my classes may have ramifications on my academic standing,
financial aid, or scholarships..
Student’s Signature: ____________________________Advisor’s Signature: _____________________________
Reason: __________________________________________________________________________________
Cumberland Campus, 3322 College Drive
Vineland, NJ 08360
RCSJ.edu | Phone: 856-691-8600 | Fax: 856-691-6483
Enrollment Change Form
Student ID#
Today’s Date
White: Enrollment Services • Yellow: Student • Pink: Advisor
DEPARTMENT COURSE # SECTION COURSE NAME CREDITS LAB FEE
INSTRUCTOR’S
SIGNATURE
(not required)
DEPARTMENT COURSE # SECTION COURSE NAME CREDITS LAB FEE
INSTRUCTOR’S
SIGNATURE
WITHDRAWAL
ADD
FOR OFFICE USE ONLY
Refund Amount
$ __________
OR
Additional Charge
$_____________ Add Fee
+_____________Tuition/Fees
$_____________TOTAL
RCSJCCCM0220
Refund: 100% 50% None
Credit hours changed: ❏ Yes ❏ No __________ to __________
Date received: ______________ Date entered: _______________
Registrar’s Signature: ____________________________________
Bursar Oce Sta Signature: ______________________________
Date: ________________________________________________
Month Day Year
— —
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
