VA WITHDRAWAL CERTIFICATION REQUEST
First and Last Name (Please Print): _____________________
Student ID: _______________________
Credit Hours Withdrawing From: _______
Semester: _____________
Program/Major:___________________________
I request to have my certification of enrollment reduced because I plan of withdrawing from the
following course(s). I understand that I still must withdraw from my course(s) through
MySnead. I understand that by withdrawing from the class, I may be responsible for repaying the
VA for the cost of the class and/or other stipends. I will contact the VA School Certifying Official
at Snead State Community College if any other changes occur to my enrollment status for the term
specified. Below is a list of the course(s) that I plan on withdrawing from at this time.
P
lease List course(s) that you are withdrawing from: (Example: CIS 146)
Co
urse 1:_________________
Web Full Term
Blended Mini I
Residential Mini II
Course 2:_________________
Web Full Term
Blended Mini I
Residential Mini II
Course 3:_________________
Web Full Term
Blended Mini I
Residential Mini II
Course 4:_________________
Web Full Term
Blended Mini I
Residential Mini II
Course 5:_________________
Web Full Term
Blended Mini I
Residential Mini II
Course 6:_________________
Web Full Term
Blended Mini I
Residential Mini II
________________________ _______________________ ____________
Student Signature Email Date
