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Santa Ana College
Admissions & Records Office
1530 W. 17th Street, Santa Ana, CA 92706
www.sac.edu
Adm_Records@sac.edu
COVID-19
FALL 2021
Excused Withdrawal
IMPORTANT: This form is to request an Excused Withdrawal (EW) due to the COVID-19 crisis. An EW will not affect your
academic probation status or towards the permitted number of withdrawals/attempts. The EW may affect other benefits
such as Financial Aid, Veterans, Sponsorship, Athletics, etc. It is recommended that you contact these programs to
understand the ramifications of this request.
Student Name: _____________________________________________________ Student ID#: _______________________
(Last) (First)
Phone: _________________________________ E-Mail: ______________________________________________________
By signing below, I am indicating that I understand the ramifications of this request for an EW grade.
Student Signature: ______________________________________________________ Date: ________________________
Course Subject/Number
(e.g. ENGL-101)
Section Number
(e.g. 54321)
Please email completed PDF form to Adm_Records@sac.edu
FALL 2021 Deadline
December 17, 2021
Fall 2021 Deadline - December 17, 2021
Please list all of the classes in which you are requesting to be withdrawn from due to the COVID-19 crisis.
Fall 2021 Deadline - December 17, 2021
