Student ID Student Name (Please Print) Student Signature Current Date
You may choose to withdraw from a class without a grade penalty if you attended the class after the class change
period (the first 5 class days of the term). The deadline for withdrawing from a class is published as part of the
academic calendar on the web (http://www.lawrence.edu/s/registrar) and is generally the second Friday after the
Mid-Term Reading Period. The class will remain on your record with a grade of ‘W’. A withdrawal does not
reduce the number of units used for billing purposes.
You will need to petition the Faculty Subcommittee on Administration for permission to withdraw if
you have or intend to withdraw from more than one class this term,
you have already withdrawn from three classes while at Lawrence,
you are on probation or strict probation, or
you are requesting to withdraw after the withdrawal deadline.
IMPORTANT: Withdrawing from a class may change your active course load to less than full time (less than 15
units for a regular term session). This can affect
the status of a student visa,
eligibility for financial aid and scholarships,
eligibility for veteran’s benefits,
eligibility to participate on an athletic team,
insurance, and
any other matters requiring you to be a full-time student.
International students should contact International Student Services. Students receiving scholarships, financial aid, or
veteran’s benefits should consult the Financial Aid Office. Students participating in athletics should contact their
coaches. If insurance or other matters apply, you should investigate the possible consequences before submitting this
Complete the grid below, obtain the required signatures, and submit this form to the Registrar’s Office.
CRN Term Subject
INSTRUCTOR ONLY—Your signature indicates this student attended your class after registration for the
term ended (after the first five class days of the term) and you have discussed this action with the student. The
student will remain on your class list and will receive a grade of ‘W’. DO NOT USE this form if the student never
attended or stopped attending during the first week of the term.
Instructor Name (Please Print) Signature Current Date
ADVISOR(S) ONLY—Your signature indicates you have discussed this action and its implications with the
Advisor 1 Name (Please Print) Signature Current Date
Advisor 2 Name (Please Print) Signature Current Date
r/ 8/18
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