Course Withdrawal Form Student ID Number:*Semester*FallSpringSummerYear*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?YesNoEmail (must be your student email)* Preferred Phone*Type*HomeBusinessCellCourse 1SessionSubjectCourse NumberSection NumberCourse TitleCourse 2SessionSubjectCourse NumberSection NumberCourse TitleCourse 3SessionSubjectCourse NumberSection NumberCourse TitleCourse 4SessionSubjectCourse NumberSection NumberCourse TitleCourse 5SessionSubjectCourse NumberSection NumberCourse TitlePlease check one or more of the following reasons for withdrawal Medical Teacher Preference Inconvenient Time Changed Mind Too Difficult Financial Personal Employment Other Student's Name*Date* Date Format: MM slash DD slash YYYY Consent* I have read and understand.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 Students are liable for all costs associated with withdrawn courses.