Withdrawal
Office of the Registrar - 111 Bray Hall
Student Name:
Date:
Student ID#:
Permanent Address:
Street Address and Apartment Number
SU e-Mail:
City State or Province Zip or Post Code Country
Home Phone: Cell Phone:
Alternate e-Mail:
Course Withdrawal Request:
I request that I be withdrawn from the following courses, with the understanding that I may elect to withdraw from an individual
course at any time between the end of the 4th week of the semester, and the end of the 14th week of the semester in
accordance with the following policy (precise deadline dates are listed in the ESF Academic Calendar). ESF Course
Withdrawal Policy: Between the end of the 4th week and the end of the 9th week, a grade of "W" will be recorded for the
course on a student's transcript, with no effect on a student's semester or cumulative GPA. Between the end of the 9th and the
end of the 14th week, the instructor of record may elect to assign a grade of "W," or "WF" if a student is deemed to be failing the
course at the time of withdrawal. Grades of both "W" and "WF" will have no impact on a student's semester or cumulative GPA.
I have read the ESF Course Withdrawal Policy provided
to me on this form and consulted with the appropriate
college offices to ensure that I fully understand the need
Student
to be registered for at least 12 credit hours to maintain
Signature
"full-time" status, as well as the potential financial aid
consequences of falling below a full-time course load.
Course Prefix &
Course
Credit
Number
(i.e. ESF 301):
Name:
Hours:
Instructor Signature:
Course Prefix &
Course
Credit
Number
(i.e. ESF 301):
Name:
Hours:
Instructor Signature:
Course Prefix &
Course
Credit
Number
(i.e. ESF 301):
Name:
Hours:
Instructor Signature:
Advisor Approval:
For your course withdrawal to take effect, you MUST
obtain your advisor/MP's approval signature and return
Advisor or
this completed form to the Office of the Registrar, 111
Major Prof.
Signature
Bray Hall prior to the published Withdrawal Deadline:
Request for Individual Course
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