Late Drop/Withdrawal
This form is used when a student is dropping any or all course(s) after the published deadline
LAST NAME _________________________________ FIRST NAME _________________________ STUDENT ID #___________________
SEMESTER/YEAR ________________ STUDENT’S SIGNATURE _________________________________________ DATE ________________
[1] You must attach all required documentation of mitigating circumstances
[2] Get all required signatures or form can NOT be processed
[3] Send completed form to the Records Office
I wish to drop the following courses after the published deadline.
The section below is to be completed by Instructors/TNeCampus contact: [Note to instructors: A grade MUST be assigned. If the student
was passing at the time of mitigating circumstances-assign a “W”; if the student was not passing and does not have mitigating
circumstances-assign an “F”] The TNeCampus contact signs for TNeCampus courses only.
Course ID __________ Grade to be issued for course is: __W __F Instructor’s signature (or TNeCampus contact) _____________________________
Course ID __________ Grade to be issued for course is: __W __F Instructor’s signature (or TNeCampus contact) _____________________________
Course ID __________ Grade to be issued for course is: __W __F Instructor’s signature (or TNeCampus contact) _____________________________
Course ID __________ Grade to be issued for course is: __W __F Instructor’s signature (or TNeCampus contact) _____________________________
Course ID __________ Grade to be issued for course is: __W __F Instructor’s signature (or TNeCampus contact) _____________________________
____________________________________________________________ _______________
Signature of Dean or TNeCampus Administrator for course Date
____________________________________________________________ _______________
Signature of Dean or TNeCampus Administrator for course Date
____________________________________________________________ _______________
Signature of Financial Aid Administrator/Designee Date
____________________________________________________________ _______________
Signature of Records Office Administrator/Designee Date
Office Use Only:
Date Rcvd ______
Processed by ____
Roll Grade______
CoSCC D-11-22-16
AA/EOE