Fourth Class Withdrawal Procedure Form (Page 2 of 2) in pdf

PART II

(Continue comments on back if needed

Cadet Company Commander: __________Concur

__________Non-concur

COMMENTS:__________________________________________________________________________________________

Signature:____________________________________________________Date:____________________________________

Company Tactical Officer: __________Concur

__________Non-concur

COMMENTS:__________________________________________________________________________________________

Signature:____________________________________________________Date:____________________________________

Battalion Tactical Officer: __________Concur

__________Non-concur

Contacted Parents:

YES

NO (Must be contacted before seeing the Chief of Staff)

COMMENTS:__________________________________________________________________________________________

Signature:____________________________________________________Date:____________________________________

PART III: Counseling Center:

I have interviewed this cadet and forward this request with the following comment(s) and recommendation(s):

______________________________________________________________________________________________________________

Signature:____________________________________________________Date___________________________________________

PART IV: Chief of Staff OR Assistant Commandant:

I have interviewed this cadet and forward cadet’s request with the following comment(s) and recommendation(s):

______________________________________________________________________________________________________________

The consent (telephone call by BN TAC) of the cadet’s parents/guardian

has been

has not been obtained.

Request/Direct that the cadet report to:

CARE

Chaplain

Infirmary

Coach

PMS

PAS

PNS (Scholarship cadets)

Director of Multicultural Student Services & International Studies (Mandatory for CSI or International Cadets)

(If cadet is referred to any of the above please fill out Part V below. If not, go directly to Part VI).

Chief of Staff or Asst. Commandant’s Signature:___________________________________Date:_______________________

PART V: Referral comments

from Part IV (if more than one referral, as indicated in Part

IV above, continue additional referral(s) on back and include the  below)

I have interviewed this cadet and forward this request with the following comment(s) and recommendation(s):

______________________________________________________________________________________________________________

Name/Signature:_______________________________________________________________Date_______________________

PART VI: Office of the Provost:

I have interviewed this cadet and forward this request with the following comment(s) and recommendation(s):

______________________________________________________________________________________________________________

Signature:____________________________________________________Date___________________________________________

PART VII: Executive Assistant to the President:

Signature:____________________________________________________Date___________________________________________

Part VIII: Admissions:

Signature:____________________________________________________Date___________________________________________

PART IX

Go to Registrar’s Office

and pick up REQUEST FOR DISCHARGE

(Yellow Card)

Signature:____________________________________________________Date___________________________________________

CC Form 97 (Revised September 2014)

Fourth Class Withdrawal Procedure Form Page 2

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