ADMINISTATIVE WITHDRAWAL FORM

 

(This form is for reporting students who have missed a minimum of 25% of attendance in their class or classes.) Please send completed form to the Admissions Office.

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Name Student ID #

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Address

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City State Zip Code

Class #

Course Title

Credits

Last Date of Attendance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Students withdrawn before the 60% point in each course will be issued a W. After that point, a student will be issued an F.

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Instructor Signature

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Date

Form Effective Fall 2005