Admissions & Records
College of the Siskiyous, 800 College Ave., Weed, CA 96094
Phone: (530) 938-5500 - Fax: (530) 938-5367 – Email: email@example.com
Add / Drop Form
Semester: Fall Winter Spring Summer Year:
Last Name: First Name: MI:
Date of Birth: Student ID#: S00 or SSN:
I verify that I am responsible for the course choices listed below and that I have read the prerequisites and advisories for
these courses in the college catalog. The information I have provided is true and correct.
Student Signature: Date:
* If you complete this form and send it through your COS email account, it will count as your signature.
I verify that I am completely withdrawing from all my courses for the above term at College of the Siskiyous.
I am withdrawing due to: Financial Military Medical Personal Other
I plan to re-enroll at COS in the next semester I do not plan to ever attend COS again at this time.
Office Use Only
Entered by: Date: