WITHDRAWAL FORM
IMPORTANT INSTRUCTIONS: This form must be first downloaded, completed and saved for submission. The saved form must
be uploaded using the withdrawal form link found under Academic Records in Self Service. This form must be submitted by
the deadline date listed in the BHCC Academic Calendar. This form must be submitted only after you have spoken with
Recommended and/or Required Representatives of the College*. Note: see the Academic Calendar for withdrawal deadlines.
Date Term BHCC ID Date of Birth
Last Name First Name MI
Are you a Dual Enrolled High School Student?
Are you a Veteran?
If yes: Contact Veterans Advisor, click here for email
Are you an F1 Visa Student?
If yes: International Advisor,
see below for email**
☐
I am withdrawing from one or more of my courses but not all courses (by the course withdrawal deadline*)
☐
I am withdrawing from all of my courses for this semester- And I plan to attend next semester.
☐
I am permanently withdrawing from the College and I do not plan to return
*Note: “W” grades will not be issued for college withdrawals received after the deadline
Please indicat
e the reason(s) for leaving BHCC.
Are any of the reasons you are withdrawing due to COVID-19?
Choose the most appropriate reason here:
Other (Please specify):
*Recommended and/or Required Consultation with Representatives of the College:
Student Central
Federal financial aid recipients
may be subject to a reduction in
their financial aid if they
completely withdraw from their
courses of any semester. All
financial aid recipients are
responsible for all costs incurred
for tuition fees, books and related
costs should their financial aid be
revised or cancelled. Students
who receive financial aid should
contact student central at:
studentcentral@bhcc.edu
Veterans/Military Benefits
Students with military benefits are
subject to a reduction of their
benefits if they partially or
completely withdraw from courses at
any point in the semester. All benefit
recipients are responsible for all
costs incurred for tuition fees, books
and related costs should their aid be
revised or cancelled. Students who
receive Veterans/military benefits
should contact the Veterans Office
about implications of withdrawal:
Stephen Roy at sroy@bhcc.edu
Advising & LifeMap
Withdrawal from course(s) or the
College impacts academic standing
as well as student progress towards
degree attainment. Students should
speak with an advisor at
advising@bhcc.edu OR through
BHCC chat by logging into BHCC
Self Service (myBHCC).
Students in the US on an F1 visa must be
enrolled in 12 credits per semester.
Students on an F1 visa must consult
with your assigned International
Student Advisor before withdrawing
from any course:
Students with last name from:
A – K contact: Sasha Johnson at
SashaJohnson@bhcc.edu
L – M contact: Ela Kijowska at
ekijowsk@bhcc.edu
N - Z contact: Heather Shapazian at
hjshapaz@bhcc.edu
SIGNATURE (Your signature indicates that you have read and understood the information above):
Student Signature: Date:
*By submitting this withdrawal form, I confirm that I have sought the counsel of recommended and required representatives
of the College, as indicated on this form, and I fully understand the academic and financial implications of withdrawing.
