COURSE WITHDRAWAL
Registrar’s Ofce
450 North Avenue • Battle Creek, MI 49017-3397
(269) 965-4129 • kellogg.edu/registrar
KELLOGG
COMMUNITY COLLEGE
INSTRUCTIONS
1. You are encouraged to speak with your instructor prior to withdrawal.
2. Print rmly with a ballpoint pen.
3. Return the form to the Records and Registration oce, Eastern Academic, Fehsenfeld, Grahl, or RMTC oce.
4. Add your reason for withdrawal.
NAME KCC ID or SOCIAL SECURITY NUMBER
Last Name First Name Middle Initial
CHECK (3) SESSION, ENTER YEAR FALL 20 SPRING 20 SUMMER 20
REASON FOR WITHDRAWAL
Academic Personal
Financial Military
Medical Other
Transfer
DATE
SUBJECT
AREA
COURSE
NUMBER
SECTION
NUMBER COURSE TITLE
CREDIT
HOURS
STUDENT SIGNATURE
Date
FOR OFFICE USE ONLY
DATE RECEIVED
BY (CLERK)
White - Registrar‘s Oce Canary - Student Copy
8/19
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