Fillable Total Withdrawal Form (Connors State College)

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Total Withdrawal Form (Connors State College)

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The Total Withdrawal Form (Connors State College) form is 1 page long and contains:

  • 1 signature
  • 18 check-boxes
  • 24 other fields

Country of origin: US
File type: PDF

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Total Withdrawal Form
This form is to be used after the initial Add/Drop period each semester.
Date Form Obtained:
Semester:
Student’s
Name:
Student ID
Number:
Last
First
Middle Initial
Current Address:
City
State
Zip Code
Current Phone Number:
Current E-Mail Address:
Do you live on campus?
Yes
No
Do you receive veteran’s benefits (i.e. G.I. Bill)? Yes No
Do you receive any financial aid (i.e. Pell Grant)?
Yes
No
Student has hold.
Yes
No
Library
Student has hold.
Yes
No
Student Housing
Student has hold.
Yes
No
Financial Aid Office
Student has hold.
Yes
No
Office of the Bursar
Student has hold.
Yes
No
Admissions Office
Student has hold.
Yes
No
Advisement
I understand that my withdrawal is not OFFICIAL until the offices of Library, Student Housing, Financial Aid, Bursar,
and Admissions have signed this form, cleared all holds, and the signed form returned to the Admissions Office for final
approval within the "Total Withdraw" date as outlined in the class schedule for this term. By signing this form, I
understand that withdrawing from all my courses could affect my financial aid, academic standing, campus housing,
Veteran’s benefits, and other areas.
Student’s Signature:
Date:
Date
Date:
Received by:
Processed by:
Notification sent to relevant campus areas:
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Total Withdrawal Form (Connors State College)

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Completed 29 January 2021

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