Sc-081 Course Withdrawal Form
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1COURSE WITHDRAWAL FORM
Please print legibly. Use black or blue ink only.
Student ID #: B
Last Name: _________________________________First Name: ______________________Term: _______________
Date Class
Course Identifier:
Reason
CRN
Course Title
Instructor
Last Date of Attendance
Began
Letters, Numbers, Section
Code
If new address,
Address: __________________________________________________________________________________ Phone: ____________________
check box.
Please Print
Street
City
State
Zip
Are you a high school dual enrollment or early admissions
Circle all that apply:
VA
Financial Aid
* Athlete
*International Student
student?
YES
NO
*
(
requires authorization)
Athletic Office Authorization _____________________________
If yes, you must complete the Dual Enrollment/Early
International Advisor Authorization _______________________
Admissions Course Withdrawal form.
IMPORTANT NOTICE: WITHDRAWING CAN NEGATIVELY IMPACT YOUR FINANCIAL AID
Students who withdraw from or stop attending all classes must repay a portion of their federal aid for the term.
Bright Futures Scholarship recipients must repay EFSC for the cost of withdrawn course(s).
Withdrawing from or not attending class(es) may negatively impact your Satisfactory Academic Progress and eligibility for federal financial aid in the future.
Visit your campus Office of Financial Aid if you have any questions about how withdrawing may impact your current or future financial aid eligibility.
I agree to pay any costs associated with the collection of unpaid, delinquent or defaulted charges, including collection costs, which may be based on a percentage
not to exceed 33% of the debt, attorney fees and court costs. Faxed or scanned/emailed withdrawals must include a legible copy of student’s legal photo ID.
SIGNATURE (REQUIRED) OF PERSON SUBMITTING THIS FORM: ____________________________________________________________ Date: _________________
Comments:
Withdrawal Reason Codes:
Student Withdrawal Codes:
Faculty/Staff Withdrawal Codes:
___________________________________________________________________
W4: Administrative Withdrawal
WA: Academic Reason
WP: Personal Reason
W5: Appeal
Withdrawal from:________________ Approval to remain in co-requisite:_________________
W6: Called to Active Duty Military
(course #)
(course#)
Co-requisite Instructor Signature: ________________________________________________
(Must present copy of orders to Associate Provost)
OFFICE USE ONLY: SFAREGS________________ SFAALST________________ Processed By:______________________________________ Date Processed: _________________
SC-081 R020816
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