SUNY
SCHENECTADY
COUNTY
COMMUNITY
COLLEGE
_____________________________________________________________________________________
_________________________________________ __________________________
WITHDRAWAL FORM
Student Name: ________________________________________________________________________
Student ID #: __________________________________________________________________________
Email Address___________________________________ Daytime phone_________________________
Address: _____________________________________________________________________________
Instructions: Use this form only if you intend to withdraw from one/all of your courses at Schenectady
County Community College. Your withdrawal is effective the date this form is processed by the
Registrar’s Office.
Please indicate the term and specific courses you are requesting to withdraw from in the table below.
Specify name of course to be withdrawn from
⃝ I am withdrawing from all the
courses in this term
ALL COURSES FROM THIS TERM*
Requires signature from Department Dean or Academic
Advisement Center.
⃝ I am withdrawing from only
the courses listed in this term
*Dean/Academic Advisement Signature:
Your withdrawal and the timing of your withdrawal may have an impact on the following:
Enrollment status
Satisfactory academic progress (SAP)
Student account
Federal, state, and institutional grants, loans, scholarships, and third party sponsorships
Please sign the completed form and return via:
In Person at the Registrar’s Office or U.S. mail (With a photo copy of a state issued ID)
Schenectady County Community College
Attn: Office of the Registrar
78 Washington Avenue
Schenectady, NY 12305
This form is not valid without your signature. Your signature affirms your request to withdraw from your course(s)
at Schenectady County Community College. If you receive any form of financial aid, including grants, loans,
scholarships, and third party sponsorships you understand your decision to withdraw may impact your financial aid
for the current and future terms. You also understand that depending on the timing of your withdrawal you may
incur financial liability for the current term and your enrollment status may be affected. Your withdrawal is
effective the date this form is processed by the Registrar’s Office.
Student Signature Date
-For Office Use Only-
Processed by: _________________________________ Date: _______________________ Refund: ___________
click to sign
signature
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