Course Withdrawal Form Student ID Number* Semester* Fall Spring Summer Year* Legal Name* First Middle Last Name used in previous attendance if different from above Home AddressStreet Address* City* State* Zip* County* County of Legal Residences* State of Legal Residences* Has your mailing or email address changed since you last registered? Yes No Email (must be your student email)* Preferred Phone*Type* Home Business Cell Course 1Session* Subject* Course Number* Section Number* Course Title* Course 2Session Subject Course Number Section Number Course Title Course 3Session Subject Course Number Section Number Course Title Course 4Session Subject Course Number Section Number Course Title Course 5Session Subject Course Number Section Number Course Title Please check one or more of the following reasons for withdrawal Medical Teacher Preference Inconvenient Time Changed Mind Too Difficult Financial Personal Employment Other I will attend all other courses that I am registered for during this semester including those that have not yet begun. (for financial aid purpose)* Yes No I am not registered for any classes that have not yet begun. Consent I confirm that I have read, understand and agree to the Withdrawal Policy below:A student desiring to withdraw from courses after the last day to drop courses (usually the 10th day of the Fall and Spring semesters and the equivalent academic period during the Summer sessions) must obtain a Course Withdrawal Form from the Registrar's Office. The student is responsible for returning this fully-completed form to the Registrar's Office by the withdrawal deadline established for each semester. A record of the course and grade will appear on the student's permanent record and transcript. Failure to attend a course does not constitute an official withdrawal and can result in a failing grade for the course. An instructor's signature is required only to verify the last date of attendance, not to approve or deny the withdrawal. If the instructor's signature and/or the last date of attendance is not completed, the office will record the last date of attendance as the date the student submitted the form. The last date of attendance may affect a student's Financial Aid award and/or eligibility for Health Insurance benefits. Students are liable for all costs associated with withdrawn courses. Signature*Today's Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.