Academic Services Office
P: 304.473.8046
F: 304.473.8531
Return completed form to the Academic Services Office via fax (304-473-8531) or email to
I hereby request permission to withdraw from:
Dept. & Course # Course Title Semester Hours
Current class load is
Adjusted class load will be
(If zero, a term WD will be processed)
My reason for wishing to withdraw (required):
Recommendation and comment of Instructor:
Signature of Instructor (Date)
_____PROMISE Scholarship recipient
_____Participant in intercollegiate athletics
_____Receiving or have you applied to receive Veteran's benefits
_____International student on an F-1 Student Visa
I have read and understand the following:
I understand tuition refunds will be processed according to the policy below
I understand that my withdrawal date may affect financial aid I have receive for summer. I understand all questions concerning how a
complete withdrawal from summer term will affect my financial aid should be directed to the Office of Financial Aid.
I understand that my grade in this course will be "W" or "WF", depending on date and approval of withdrawal from the course.
Date Signature of Student
Email: ______________________________________ Campus Box ______________
Students making schedule changes that results in a reduction of load during the first two days of a summer term (add/drop period) will
receive refunds of the difference in tuition charges according the schedule listed above for withdrawal from the College. After the
first two days of the term (add/drop period), course fees are not refundable.
Policy for Withdrawal from the College
Students are required to notify the Registrar’s Office to complete the withdrawal from school process. If a course withdrawal results in a zero credit
course load for a summer term, a term withdraw will be processed according to the following schedule:
May Term 2020 Summer Term 2020 Student Responsibility
May 6 – May 9 June 4 – June 7 20% of tuition
May 10 – May 13 June 8 – June 11 40% of tuition
May 14 – May 17 June 12 – June 14 60% of tuition
After May 17 After June 14, 2019 100% of tuition
Approved ___________ Not Approved ___________ Date Posted ______________________
Processed: _____ RGN _____STAC _____FA
Name of Student