Class Withdrawal

Is this an Administrative Class Withdrawal? (if filled by staff or faculty only)*

Yes No

Staff or Faculty Name*

First Name

Initial

Last Name

Student Name*

First Name

Initial

Last Name

Student Email*

Confirm Student Email *

Class requesting to be withdrawn from*

Instructed by*

For the following reasons*

Last day of attendance*

Total semester credits remaining*

(After change)

Advisor Email*

Signature*

Use your mouse or finger to draw your signature above

Professor/Instructor Email*

Date