MARTIN COMMUNITY COLLEGE
Revised: 03/18/2020
WITHDRAWAL FORM
TUDENT
ESPONSIBILITY
Students are responsible for completing this form and obtaining each instructor’s signature
prior to submitting it to the Registrar’s Office.
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To be officially withdrawn from a course(s), this form must be received in the Registrar’s office on or before the published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.
AST
AME
IRST
AME
IDDLE
NITIAL
TUDENT
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
NSTRUCTOR
SIGNATURE OR
EMAIL
D
ATE LAST
ATTENDED
DMINISTRATIVE
ITHDRAWAL
HILD
ARE
ISSATISFIED WITH
NSTRUCTOR
OURSE
INANCIAL
EASONS
RADES
LLNESS
OURSE
OAD
OO
EAVY
THER
RANSPORTATION
ORK
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 REGISTRAR’S OFFICE STAFF _________________________________________DATE________________
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