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The University of TexasHouston

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Students: PLEASE BRING SIGNED COPY TO THE OFFICE OF THE REGISTRAR, UCT 2250
SAO’s: Please fax or send as email attachment to the Registrar’s Office
The University of Texas—Houston
Subject Catalog No. Secon Title
Credit
Hours
Re-take Audit Add
Instructor’s Signature
Add
Acon
Student is withdrawing from the institution: Yes No If Yes, SCHOOL must enter last date of attendance below.
I understand that 100% refunds are not issued after the first class day even if a student’s specific classes start after that day. I understand that if I am on a payment plan, I am still responsible for the
original tuition and fee charges and that even if I resign during a refund period, I may still have future payments due on my plan.
Subject Catalog No. Secon Title
Credit
Hours
Undergrad
6-Drop
Grade Instructor’s Signature
Counts
Exempt
Counts
Exempt
Counts
Exempt
Counts
Exempt
Drop/Withdrawal
Add-Drop/Withdrawal/Audit Form
Applicable Grades:
W, WF—SON, MDA-SHP
WP, WF—SOD Adv Ed, SBMI, GSBS
W—SPH, SOD DHy
For Withdrawal, SCHOOL enters the last day of class attendance (mm/dd/yyyy)?
2/18/2020
Student’s Signature
Date
Dean/Student Aairs
Date
Internaonal Aairs
Date
Advisor
Date
(Not required for U.S. Cizens or U.S. Permanent Residents)
Name:
Last
First
MI
,
Student Number:
School:
Term:
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The University of TexasHouston

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Completed 6 October 2021

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