Fill - Free fillable Late Drop/Withdrawal This form is used when a (Columbia State Community College) PDF form

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) _____________________________

____________________________________________________________ _______________

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

Date Rcvd ______

Processed by ____

Roll Grade______

CoSCC D-11-22-16

Fill Online, Printable, Fillable, Blank Late Drop/Withdrawal This form is used when a (Columbia State Community College) Form