Fillable WITHDRAWAL FROM COLLEGE (Erie Community College)

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WITHDRAWAL FROM COLLEGE (Erie Community College)

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The WITHDRAWAL FROM COLLEGE (Erie Community College) form is 1 page long and contains:

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Country of origin: US
File type: PDF

U.S.A. forms for Erie Community College

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WITHDRAWAL FROM COLLEGE
*
Please submit a form of ID (copy of license, student ID) along with
this document*
SSN or Student I.D.
Student Name
Street Address
City, State, Zip Code
Student Major
Campus
Semester/Year of Withdrawal
Last Date of Attendance
RECEIVING BENEFITS FROM (Check All That Apply):
TAP VETERANS SS TITLE IV FUNDS: PELL LOANS
REASON FOR WITHDRAWAL:
COUNSELOR SIGNATURE DATE
STUDENT SIGNATURE DATE
WITHDRAWAL CODE PECENTAGE OF REFUND
The withdrawal form originates in the Counseling Center. Refunds will be calculated from the
date the withdrawal procedure is completed. The Admission Fee, Activity Fee and Accident
Insurance are not refundable. Tuition refunds are made at the following rates to students who
withdraw: prior to the first day of Fall or Spring Semester: 100%; during the first week of
instruction: 75%; during the second week of instruction: 50%; during the third week of instruction:
25%. NO REFUNDS WILL BE MADE AFTER THE THIRD WEEK OF INSTRUCTION. (For Complete
Statement, See College Catalog)
Distribution: White: Registrar Yellow: Counseling Pink: Department Goldenrod: Student
Date Processed Initials
Rev. 9/15 RegC Forms.college withdrawal.doc
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WITHDRAWAL FROM COLLEGE (Erie Community College)

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Completed 29 January 2021

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