One College Drive
Calais, ME 04619
Enrollment & Student Services 207-454-1013
: Washington County Community College is an equal opportunity/affirmative action institution and
employer. For more information; please call Tatiana Osmond, Affirmative Action Officer, at 454-1094.
RE – Form Course Withdrawal PC: Advisor
Revised: July 8, 2019; amd
Fall _____ Spring_____ Summer_____ 20_____ Date: _____________________________________
Last Name: ___________________________________ First Name: __________________________________ M.I.: _____________
Mailing Address: _______________________________________ City: ______________________ State: _________ Zip: ________
Phone Number: ___________________________________ Mobile Phone Number: ________________________________________
Cell phone carrier: US Cellular Verizon AT & T Tracfone Other __________ Text Updates: ___Yes ___No
Student ID #: _____________________________ Email address: ______________________________________________________
Program of Study: ____________________________________________________________________________________________
Course Withdrawal will result in a grade of W. This grade will not impact grade point average,
but could impact financial aid and will impact completion rate.
This form is only valid when completed and submitted by the student between the first and
eighth week of classes (prorated for shorter term courses).
Instructor please provide student’s Last Date of Attendance ___________________
Instructor Signature: ______________________________________________________________________Date:________________
The procedure for processing is as follows:
1. The student is to complete form and obtain signature and last date of attendance from instructor.
2. Student is to return the form to Donna Geel in room 105.
3. The original copy is filed in the student’s permanent file.
Student Signature: _______________________________________________________________________Date:________________
For Office Use Only
Enrollment Initials _______________ Date__________