Course Add/withdrawal Form
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1COURSE ADD/WITHDRAWAL FORM
This form must be completed and returned to the Registrar’s Office (UC 215). Failure to return the completed form will result
in a failing grade for the enrollment period selected and course(s) listed below.
Enrollment Period:
Fall
Spring
Intersession
Summer I
Summer II
Year: ________________________
Select Type Of Withdrawal:
Partial Withdrawal
( I wish to withdraw from one or more courses, but not all my courses)
Complete Withdrawal
(I wish to withdraw from all my courses)
Student Name: ________________________________________________ Student I.D. No.: _______________________________
Signature: _____________________________________________________ Date: _________________________________________
(Student)
Add
Drop
Line No.
Course No.
Course Title
Instructor
IN THE ORDER LISTED BELOW, you must receive the following signatures before your withdrawal will be processed.
1.
Signature: ________________________________________________ Date: _________________________________________
(Advisor or Division Chair)
2.
If this is a complete withdrawal, you must have a signature from the library.
If not, proceed to number 3.
Signature: ________________________________________________ Date: _________________________________________
(Library)
3.
Did you receive any type of financial aid this semester?
Yes
No
If yes, you must go to the Financial Aid Office. If no, proceed to number 4.
Signature: ________________________________________________ Date: _________________________________________
(Financial Aid)
4.
Signature: ________________________________________________ Date: _________________________________________
(Student Accounts)
ATTENTION: If this is a complete withdrawal, you will receive a withdrawal survey in the mail.
Information gathered from the survey will be used to better serve our students.
OFFICE USE ONLY
ADMINISTRATIVE CHANGES APPROVED
Registrar’s Office Stamp
ADV. _________________________
Indicates Effective Date
YES
NO
Approved by: _______________________
FINANCIAL AID REPAY AMOUNT
(IF REQUIRED)
Date: _______________________________
$ ___________________________
Rev: 10/16/2015
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