To request a grade of ‘W’ for one or more classes, please complete and submit this form to
Advising@Reynolds.edu. The deadline to withdraw from full-semester classes is published in the Class
Schedule and in the college’s calendar on the college web site:
http://www.jsr.vccs.edu/get_started/calendars.aspx. Withdrawal deadlines for shorter or longer classes can be
obtained in the Advising Center
.
A grade of ‘‘W’ will be assigned for on-time requests, and your grade point average will not be affected. You are encour-
aged to discuss your decision with your instructor or advisor, if you have not already done so.
Please note that Withdrawals do not qualify for refunds and that they can negatively affect continued
financial aid eligibility
Section A – Completed by the Student:
Current Term: Check one
FALL SEMESTER (Aug-Dec) 20 SPRING SEMESTER (Jan-May) 20 SUMMER SESSION (May-July) 20
Student’s EmplID:
Date of Birth:
Student’s Last Name Student’s First Name MI Jr.,3rd
I am aware that withdrawing from a class(es) can negatively effect my eligibility to receive Financial Aid.
I understand that withdrawing from class(es) may put me in a situation where I owe money to the college for
tuition and fees
SIGNATURE OF STUDENT: DATE:
Please complete Columns A,B,C,D,E,F and G below:
Nbr
Subject
Class
Number
Section
Number
Campus
Class Title
Last Date You
Attended Class
25741 ENG 111 01A Parham College Composition I
Sept. 10, 2002
For Advising Center Use Only:
Withdrawal Deadlines:
On Time
Late — informed student
Financial Aid discussed with student
Have used Military Education Benefits?
Processed by: Date:
JSRCC Form No. 11-0004 Request to Withdraw from Class(es) form 04/2020
Request to Withdraw from Class(es)
EXAMPLE
EXAMPLE
EXAMPLE EXAMPLE EXAMPLE EXAMPLE
EXAMPLE
click to sign
signature
click to edit
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click to sign
signature
click to edit
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