Fillable WITHDRAWAL FORM Use this form to withdraw from (Wesleyan University)

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WITHDRAWAL FORM Use this form to withdraw from (Wesleyan University)

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WITHDRAWAL FORM
Use this form to withdraw from a course after the drop/add period and BEFORE the
withdrawal deadline.
To withdraw from a course after the withdrawal deadline, use the Petition form.
For withdrawal deadlines, see the Academic Calendar.
___________________________
______________________________________________
___________________________
___________________________
WesID
Last Name
First Name
Class Year
_____________________________________________
Student’s Signature Are you an F1Visa Holder? ☐ Yes or ☐ No
_________________________________________
Faculty Advisor’s Signature mm/dd/yy
UNDERGRADUATE STUDENTS
_________________________________________
Class Dean’s Signature mm/dd/yy
GRADUATE STUDENTS
______
_______________________________________
Graduate Student Services Signature mm/dd/yy
SEMESTER
Course Subject
Instructor’s Printed Name, WesID, and Signature
Date (mm/dd/yy)
Semester:
☐Fall ______
☐Spring _____
1
2
3
4
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WITHDRAWAL FORM Use this form to withdraw from (Wesleyan University)

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Completed 24 July 2020

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