SUMMER 2020 ONLY
REQUEST TO WITHDRAW FROM A COURSE
Instructions: Fillable .pdf forms need to be downloaded, filled out, saved, then emailed from your Union email account,
as it acts as the signature. (Works best if you open with Adobe). Email the completed form to firstname.lastname@example.org along
with permissions. In lieu of the signatures, permission can come in the form of an email as long as it comes from their
Last Name First Name MI Student ID # Class Year
I request to WITHDRAW from:
Course Dept - Number – Section Instructor’s Name
Once I withdraw, I understand that I cannot re-add this course later in the term.
Students will receive email notification that the Withdrawal has been processed on this course.
Schenectady, NY 12308
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