MARTIN COMMUNITY COLLEGE
Revised: 03/18/2020
WITHDRAWAL FORM
S
TUDENT
R
ESPONSIBILITY
Students are responsible for completing this form and obtaining each instructor’s signature
prior to submitting it to the Registrar’s Office.
I
NTERNET
/
TRADITIONAL CLASSES
Students must obtain instructor’s signature and last date of attendance. Students enrolled
in online courses may email the instructor(s) to inform them of their intent to withdraw
from a class and attach a copy of the instructor’s response to this form. The instructor
should state the last date the student submitted work in the Internet class in the response.
To be officially withdrawn from a course(s), this form must be received in the Registrar’s office on or before the published
Last Day to Withdraw before receiving an “F” deadline of the course according to the Academic Calendar.
L
AST
N
AME
F
IRST
N
AME
M
IDDLE
I
NITIAL
S
TUDENT
ID
N
UMBER
PROGRAM
TERM FALL SPRING SUMMER YEAR_____
INSERT A
IN THE APPROPRIATE TERM BOX
WITHDRAWAL
DROP
C
ODE
C
OURSE
PREFIX
C
OURSE
NUMBER
S
ECTION
NUMBER
C
REDIT
HOURS COURSE TITLE
I
NSTRUCTOR
SIGNATURE OR
EMAIL
D
ATE LAST
ATTENDED
*DROP REASON:
(AW)
A
DMINISTRATIVE
W
ITHDRAWAL
(C)
-
C
HILD
C
ARE
(DI)
-
D
ISSATISFIED WITH
I
NSTRUCTOR
/C
OURSE
(F)
-
F
INANCIAL
R
EASONS
(G)
-
G
RADES
(I)
-
I
LLNESS
(L)
C
OURSE
L
OAD
T
OO
H
EAVY
(O)
O
THER
__________________
(T)
-
T
RANSPORTATION
(W)
-
W
ORK
S
CHEDULE
Advisor signature, instructor signature, and the last date of attendance is not required when reversing an AW”.
SIGNATURE OF ADVISOR OR EMAIL ____________________________________________________________________
S
IGNATURE OF STUDENT _____________________________________________________________________________
S
IGNATURE OF REGISTRARS OFFICE STAFF _________________________________________DATE________________
REGISTRAR’S OFFICE
ADVISOR
INSTRUCTOR
FINANCIAL AID
STUDENT
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit
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