Add/Drop and
Withdrawal Form
Student ID Semester of Registration: Year 20____
Number / SSN Fall Spring Summer
*Please note that your social security number is required during your initial admissions process.
Legal Name: Last:_____________________________ First:__________________________ Middle Initial:_______
Previous Name (maiden):_____________________________________________________________________
Mailing Address: Street/P.O. Box:________________________________________________________ Apt.:________
City:___________________________________________ State:___________ Zip:_____________
Telephone: Home:(_____)______________ Cell: (_____)______________ Email: ______________________________
Date of Birth:________/________/________
Month Day Year
Financial Aid Recipients: It is the responsibility of the student to notify the Financial Aid office of any change in program of interest.
Residence Hall students: A minimum of a 6 credits is required to live in the residence halls.
Requesting an Official Withdrawal: Students can request an official withdrawal during the first two-thirds of the class based on the beginning and end date as listed in the
schedule of classes. During this period a student may withdraw regardless of reason and must initiate and complete the withdrawal request through the registration office.
Instructor permission is not needed. During the final one-third of the course, if there are extenuating circumstances, a student can request an official withdrawal. The approval of
both the instructor and division chair or program director will be required.
Tuition and fees are due at the time of registration: Failure to make payment and/or payment arrangements will results in the loss of registration.
Refund Policy: Regular Semester Length Classes: 100% of tuition/fees will be refunded if the official withdrawal is completed prior to the class start. 90% of tuition/fees will be
refunded if the official withdrawal is completed during the official add/drop period. There are NO refunds issued for withdrawals completed after the official add/drop period. Short
Term Classes: 100% of tuition/fees will be refunded if the official withdrawal is completed prior to the class start. There are NO refunds for short term classes after the start of the
class.
Check One:
Add Drop
(ex.
Course Number
(ex. MAT082)
Course Title
(ex. Basic Arithmetic)
Approval Signature
(if required)
By signing below, I certify that the information given is complete to the best of my knowledge. I understand that submission of false
information is grounds for denial of admission or immediate suspension if enrolled. As a student of Central Arizona College, I agree to abide
by the Student Code of Conduct of the college regarding conduct and other obligations. In addition, I understand that Central Arizona
College institutional student business by electronic delivery. This includes, but not limited to admissions, registration and billings, Form 1098-
T and direct deposits. You may withdraw your consent of electronic delivery by writing Central Arizona College, Attn: Accounts Receivable,
8470 N. Overfield Road, Coolidge, AZ 85128.
___________________________________________________
___________________________________
____________________
Academic Dean
Max Hour Approval:
______________
Revised Oct.2018
Complete Withdrawal from Central Arizona College
I would like to request a complete withdrawal from all courses. If I am withdrawing after the official add/drop week and prior to the last day to withdrawal, I understand that I
will receive a grade of ‘W’ which will be part of my permanent academic record and will appear on my student transcript. I am also financially responsible for the tuition and fees
for these courses and for any other fees or fines I may have incurred, such as library fines, parking tickets, etc. It is my responsibility to contact the Cashier’s Office to resolve
any outstanding financial obligations. Student transcript will not be released if there are any outstanding financial obligations owed to the College.
Reason for dropping (please check all that apply):
Leaving the area/moving Dissatisfaction with the course/instructor Child Care Advice of Instructor/Advisor
Difficulty of course(s) Dissatisfaction with services Transportation Personal
Loss of interest Financial Reasons Change of Degree/Certificate Other (please specify)
Schedule/employment conflicts Medical Reasons Too many classes
Have you consulted a faculty member or an advisor regarding the above issues? Yes No
If you are receiving Financial Aid, an exit interview must be conducted by the Financial Aid Office.
Exit Interview Completed:
Yes No Date: ____________________ Financial Aid Advisor Signature:_____________________________________
Aravaipa
Maricopa
San Tan
Signal Peak
Superstition Florence Casa Grande Center
Casa Grande Corporate Center
click to sign
signature
click to edit
![]()
