Spring 2020 Term Withdrawal Request
For Spring 2020 only, faculty and chair signatures, as well as supporting documentation
are not required, per Senate Resolution 19-02
The last day to submit this form is 30 days after the end of the term.
You may submit the form to the Enrollment Center, first floor, Sage Hall, or you may submit via email to registrar@csuci.edu.
**Student Checklist for Requesting a Full Withdrawal from Spring 2020**
Withdrawals will be noted as a “W” on the transcript.
Enter course information below.
Enter the reason on the form. Please be sure to indicate if your reason is COVID-19 related.
Sign and date the bottom of the form. If you are unable to sign, please type your name on the signature line.
First Name __________________________ Last Name _______________________ Student ID _____________________
Phone _____________________________ Email_______________________________________________________________
Please give reason for drop:
Student Signature __________________________________________________ Date _____________________
Registrar’s Office Use Only
Processed (Initials/date): _______________Last Date of Attendance: __________________ Notification (date): ________NSC Updated:________CARE Report:________
Subject and Course
Number
Enrollment Management
Registrar’s Office
One University Drive
Camarillo, CA 93012
Phone: (805) 437-8500
