Fourth Class Withdrawal Procedure Form
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1
2FOURTH CLASS WITHDRAWAL PROCEDURE
This form must be completed in its entirety prior to receiving REQUEST FOR
DISCHARGE (Yellow Card) from the Registrar’s Office.
Part I
: General Information (TO BE COMPLETED BY THE 4
CLASS CADET).
TH
Name:____________________________________________________Company:__________CWID#:_______________________
Participated in Weekend Visit:
NO
YES
Participated in CSI Program:
NO
YES
NCAA Athlete? :
NO
YES (Sport___________________________)
ROTC:
Air Force
Army
Navy/Marine
State of legal residence:__________________________ Major:_______________________ SAT/ACT Score:____________
Scholarship recipient?
NO
YES (Name of scholarship_________________________________________________)
Parent or Guardian Name:____________________________________________________________________________________
Address:_______________________________________
Cell Phone #: ______________________________________
______________________________________________
Home/Work Phone #: ________________________________
Why did you choose to attend The Citadel?____________________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Why are you choosing to withdraw from The Citadel?__________________________________________________________
______________________________________________________________________________________________________________
______________________________________________________________________________________________________________
Have you been subjected to any violation of the Fourth Class System?
*I have /
I have not
*Have you been prevented from eating enough, been verbally or physically abused, been interrupted during
ESP or when sleeping, or any other violation you deem inappropriate? (If so, please state all pertinent facts
to include what, when, how, and by whom on an attached sheet).
Have you been sexually harassed, abused or assaulted?
NO
YES
Have you been hazed ?
NO
YES
If yes, how, when, and by whom?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Have you been discriminated against based on gender, race, ethnicity, or sexual orientation?
NO
YES
If yes, how, when, and by whom?
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Have you told your parents about your decision to withdraw?
NO
YES- If yes, when?______________________
Do your parents support your decision?
NO
YES
Cadet’s signature:__________________________________________________________ Date:_____________________________
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