* Required Information
Summer
(Month)
Fall
(Month)
Spring
(Month)
Student ID Number
*
INDICATE REASON FOR WITHDRAWAL
Work schedule change
Moving from area
Illness
Transportation problems
Dissatisfied with course
Academic difficulties
Other
Have you stopped attending class?
Yes
No
Last Name
*
First Name
*
MI
Date
Course Code
Section No.
Course Title
Credit Hours
Total semester hour
Are you receiving any veteran benefits?
Yes
No
Students are strongly advised to discuss the academic impact of withdrawing from classes with their instructor, counselor, and/or career program coordinator prior to withdrawing.
Student Name
*
Date
A “W” Withdrawal will be recorded on the official record for students wishing to discontinue attendance in classes after the end of refund period providing the proper procedure is followed.. A Final Grade will be issued for all courses for which an official withdrawal has not been Processed by the deadline. Please retain a copy of this document as your official proof of withdrawal.
Registrar’s Name
*
Date
Processed By
*
Date
THE OFFICIAL WITHDRAWAL DATE IS THE DATE THIS FORM HAS BEEN COMPLETED AND PROCESSED BY THE REGISTRATION STAFF.12/2010
Tuition refunds are available ONLY in accordance with established college policy:
* Before the first class: 100%
* Before the second meeting of a class lasting four or more weeks: 50%
* No refund is given for one-day classes
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