Withdrawing from Courses
Have you had a conversation with your professor BEFORE you withdraw YES NO
This form is to be used to withdraw from one or more courses the day after the refund schedule ends- click
for refund schedule if you are viewing this online
Click here for Withdrawal Dates if you are viewing this online
This form may be brought to the Records and Registration Office (SCC 220) or scanned and emailed to
There is a $10.00 fee per withdrawn course in accordance with the Tuition/Fee Schedule
Please Print: Name ___________________________________________CCM ID _____________________
Withdrawing from one or more of your classes may affect your financial aid and/or your enrollment
status (ie: full time, part time, etc.). Please check with the Financial Aid Office before withdrawing!
No Are you receiving Financial Aid (grants, scholarships, loans)? Yes (if yes, signature is needed below)
Financial Aid Counselor ________________________________________________________________
Are you a veteran? Yes No Are you an athlete? Yes No
Please indicate (below) the appropriate semester/mini term for the course you are withdrawing from:
Semester: (check one) Fall Spring Summer Winter YEAR ______
Course #
Section #
Course Title
Rec and Reg Use Only
Why are you withdrawing? Choose one reason per course and indicate in the Reason Code column.
DISC - Dissatisfied with Course
EMP - Employment
FIN - Financial
MED - Medical
MIL - Military
PER - Personal
Are you withdrawing from all of your classes this term? Yes No
Student Signature ____________________________________________ Date_________________
If this form was not emailed, completed/signed form must be turned in to Records and Registration (SCC 220) for processing!
Processed by Rec and Reg ___________ Date Processed ________________
White Records & Registration Yellow Bursar Pink Student REG 6/2019