Office of the Registrar
DS 120
Office of the Registrar
8/2018
WITHDRAWAL FROM CLASS FORM
STUDENT NAME: __________________________________________ DATE: ____________ STUDENT ATHLETE □ YES □ NO
MAJOR: ____________________________________ STUDENT ID NUMBER: _______________________ ANTICIPATED GRAD YEAR: ___________
mm/yyyy
Are any of the courses selected designated as Service Learning courses: □ YES □ NO
NOTE:
Repeated patterns of withdrawal may be cause for review by the Committee on Academic Standards.
A student contemplating withdrawal from a course should consult his/her academic advisor before doing so. If you are receiving financial aid, consultation with
a Financial Aid Officer is also advised.
Full time undergraduate students who are reducing the course load below twelve credit hours: please read and complete the following:
o Do you currently receive financial Aid? □ YES □ NO
o IF YES, it is advisable to obtain the signature of a financial aid counselor to signify review of the effect of the requested withdrawal(s) on continued aid
eligibility. ________________________________________
Signature of Financial Aid Counselor
REQUIRED SIGNATURES
**If you are a STUDENT ATHLETE this form will not be processed unless signed by the Associate Athletics Director of Compliance**
___________________________________________ ____________ __________________________________________ ____________
Signature of Student Date Signature of Advisor Date
___________________________________________ ____________ __________________________________________ ____________
Date Signature of HEOP Advisor Date Signature of Career Services
(If Drop/Withdrawal from Internship) (HEOP student’s only)
___________________________________________ ____________ ____________
Signature of Service Learning Director Date Date
(If Drop/Withdrawal from SL course or SL Add-on)
_________________________________________
Signature of Athletics Director or
Director of Compliance
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