Enrollment Services
Records and Registration
One University Drive
Camarillo, CA 93012
Phone: (805) 437-8500
Withdrawal Request for Term
Name Student ID
Phone
No Withdrawal is permitted during the last three weeks of classes except “for serious and compelling
circumstances beyond the student's control.” Supporting documents must be provided. Please refer to the
Schedule of Classes for the University Refund Policy, dates and deadlines.
Class # Subject Course # Section Units
Instructor Signature
Chair Signature Date
Reason (s) for Term Withdrawal- Attach additional documentation as needed:
Student's Signature Date
For Records & Registration Administrative Use Only
Type of Withdrawal: W/Financial W/Medical Other All Holds Cleared? Yes No
Processed by: ________ PeopleSoft Update: ________ Student Notification Sent: ________
(Staff Initials) (Date) (Date)
G:/AR/80/Forms/Records/Student Forms/F09-Term Withdrawal/ Revised 4/13/2011
Email
Address City State Zip
Please verify your course schedule at CI Records on myci.csuci.edu
Academic Affairs Clearance Signature
Financial Aid Clearance Signature
Student Business Services Clearance Signature
*Housing Clearance Signature (*if applicable)
University Registrar Signature Required
If you have any outstanding obligations to the University, this request will not be processed until all
the above signatures are obtained.
Date
Date
Date
Date
Date
DeniedApproved
Required signatures
Print Form
Calendar Period Drop Class
Complete Withdrawal
Add Class
Change of Grading Basis
Late Registration
Weeks 1-3
Beginning Week 4:
students dropping a
class will receive a W
Drop class(es) using the
“Change of Program” form
(instructor approval not
required)
Or Drop via the web:
myCI.csuci.edu, CI Records
Drop class(es) using the “Change
of Program” form (instructor
approval not required)
Or Drop via the web:
myCI.csuci.edu, CI Records
(Consult the Financial Aid office
if you are receiving funds)
Add using the “Change of
Program” form (instructor
approval required)
Or Add via the web:
myCI.csuci.edu, CI Records
File “Change of Program”
form in the Enrollment Center
Register using the “Change of
Program” form (instructor approval
required)
Or Add via the web:
myCI.csuci.edu, CI Records
$25.00 Late Registration Fee in
addition to other fees.
Week 4
Students dropping a
class will receive a W
Allowed for serious and compelling reasons.
File “Change of Program” form in the Enrollment
Center.
(instructor and program chair approval required)
Enter reasons on form. Additional documentation may
be required.
Normally not permitted.
File “Change of Program”
form in Enrollment Center.
(instructor and program chair
approval required)
Enter reasons on form.
Additional documentation
may be required.
NOT PERMITTED
Normally not permitted.
File “Change of Program” form in
Enrollment Center. (instructor and
program chair approval required)
Enter reasons on form. Additional
documentation may be required.
$25.00 Late Registration Fee in
addition to other registration fees.
Weeks 5-12
Students dropping a
class will receive a W
Allowed for serious and compelling reasons.
File “Change of Program” form in the Enrollment
Center.
(instructor and program chair approval required)
Enter reasons on form. Additional documentation may
be required.
NOT PERMITTED
NOT PERMITTED
Normally not permitted.
File “Change of Program” form in
Enrollment Center. (instructor and
program chair approval required)
Enter reasons on form. Additional
documentation may be required.
$25.00 Late Registration Fee in
addition to other registration fees.
Last 4 weeks of
instruction to end of
term
NOT PERMITTED
Allowed only for serious and
compelling circumstances
beyond a student's control.
File a Withdrawal Request for
Term form. Signatures must be
obtained by Academic Affairs,
Financial Aid, Student Business
Services, Housing (if applicable)
and the University Registrar.
Reason must be entered on the
form; documentation is required.
NOT PERMITTED
NOT PERMITTED
NOT PERMITTED
Late Registration/Change of Program is not official until processed in the Enrollment Center
Please make every effort to complete all of your changes during the first three weeks of the semester.
Student eligibility for financial aid is based on enrollment. A student who completely withdraws from a period of enrollment (including medical withdrawals) may be subject to repayment. Financial aid
recipients should consult a financial aid representative for more information.
Criteria for Late Add/Drop or Changes in Basis of Grading
Students should note that a deficient academic performance is not a sufficient reason for dropping a class or changing the basis of grading after the third week. Students must present proof of a serious and
compelling reason for withdrawal.
Medical Withdrawal
A medical withdrawal constitutes complete withdrawal from the University for the academic period in question. Beginning with the fourth week of the semester, students who find it necessary to withdraw
from the University for medical reasons may be required to present documentation. Financial aid recipients should consult a financial aid representative regarding the implications of a complete
withdrawal.
California State University Channel Islands, One University Drive, Camarillo, CA 93012 /805-437-8500/ www.csuci.edu
CSU Channel Islands Policy on Withdrawal from Courses
1. Students may drop courses during the first three weeks of classes without instructor permission.
2. After the third week of classes and before the end of the tenth week of classes, withdrawal from courses is permissible only for serious and compelling reasons. Approval signatures from the instructor
and program chairs must be obtained to withdraw during this period. The withdrawal will be noted as a "W" on the student's permanent record.
3. After the tenth week of instruction, withdrawal is not permitted except in cases beyond the student's control such as accident or serious illness where the assignment of an Incomplete is not practical.
Approval signatures from the instructor, program chair and Vice President for Academic Affairs (or designee) must be obtained. Withdrawal in this category will typically involve total withdrawal from
the University and will be noted as a "W" on the student's permanent record.
4. Instructor Initiated Withdrawal: Instructors may drop students within the first three weeks of classes and as early as the first day of classes for any of the following reasons:
a) Student failure to attend class without having made prior arrangements with the instructor.
b) Student failure to complete the prerequisites for a course before enrolling.
c) Student failure to secure properly the permission of the instructor before enrolling when such permission is required.
(SP03-07)
U:\Records&Registration\Term Withdrawal 09/28/09
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