_________________________ _________________________ ____ __________________
_________________________________________ ____________________
Suffolk County Community College
Course Withdrawal
Use this form if you wish to withdraw from a course after the drop course period has ended.
Please complete in the following sequence:
1. Before withdrawing from a course, students receiving financial aid or have filed for a student loan must
speak with the Financial Aid Office to determine how this withdrawal may affect you in this or a future
term. Therefore, please send an email using your SCCC email account to one of the following email
addresses, and include your name and ID#:
faidammr@sunysuffolk.edu Ammerman Campus Financial Aid
faideast@sunysuffolk.edu Eastern Campus Financial Aid
faidwest@sunysuffolk.edu Michael J. Grant Campus Financial Aid
2. Email this form, using your SCCC email account, to your instructors for their approval, and to your
home campus Registrar Office.
registrara@sunysuffolk.edu – Ammerman Campus Registrar
registrare@sunysuffolk.edu Eastern Campus Registrar
registrarw@sunysuffolk.edu Michael J. Grant Campus Registrar
Completing this process on or before the midpoint of the term assures you a “W” in the course(s).
After this time, your instructor has the option of assigning either a “W” or a grade of “F.”
Last Name First Name M.I. ID#
I wish to withdraw from the following course(s):
(Sample: Campus = A, E, W / CRN = 91508 / Subject = ENG / Course = 101 / Credits = 3)
Campus
CRN
Subject
Course
Credits
Instructor’s Signature
(if after the midpoint)
Reason:__________________________________________________________________________________________
Last date of attendance in class(es):____________________________________________________________________
When withdrawing from a class, I understand:
You must initial below
.
1. I may not be eligible for any financial aid next term. ____ (initial)
2. My federal financial aid (PELL, SEOG, etc.) may be subject to adjustment this term.
This may result in my owing money to the college. ____ (initial)
3. I am not due a refund and still retain liability for any unpaid charges associated with the course
withdrawal. ____ (initial)
4. I may be placed on academic probation (see catalog for more information). ____ (initial)
Print Full Name Date
******************************************************************************************************************************************
For Office Use Only: (SFAREGS)
Processed by: __________________________ Campus: _______________ Date: __________________
Revised: 6/26/2020
Select
Select
Select
Select
Select
Select
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome