03/23/20
Yuba Community College District
Financial Aid Offices
2020-2021 INSTRUCTOR CERTIFICATION OF ATTENDANCE
_______________________________
Date
_________________________________________________ _______________________________
Last Name First Student ID
Term: Fall 2020 Spring 2021 Summer 2021
Dear Instructor,
The Financial Aid Office has been notified that the student listed above has withdrawn from or received a failing
(F, NC, W) grade in your course. In order to comply with Federal regulations, we need your assistance in
determining the date this student last attended your class. Please complete the items below and return this
form to the Financial Aid Office as soon as possible.
If you have any questions or need additional information, please contact the Financial Aid Office.
TO BE COMPLETED BY INSTRUCTOR ONLY
Course Name and Number ___________________________________________
Check the item that applies to the student:
The student completed this course and earned an “F” or “NC” grade.
The student attended at least one class meeting, but the date of withdrawal is unknown.
The student stopped attending this class/course on ______________________________________.
(Date last attended)
The student never attended this course.
_________________________________________________ _______________________________
Instructor’s Signature Date Instructor’s Name (Print or Type)
_________________________________________________ _______________________________
Instructor’s E-mail Contact Phone Number
2088 North Beale Road
Marysville, CA 95901
530-741-7999
Woodland Community College
2300 East Gibson Road
Woodland, CA 95776
530-661-5725
15880 Dam Road Extension
Clearlake, CA 95422
707-995-7923
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