Student Drop and Withdrawal Form

Student Drop and Withdrawal Form
Use this form if you need help dropping or withdrawing from a course.
- If you submit the form by the add/drop deadline, the course will be dropped (deleted) from your schedule.
- If you submit the form after the add/drop deadline but by the withdrawal deadline, you will receive a W for the course.
If you are attempting to request a withdrawal for a course where the withdrawal date has passed or the course was taken during a previous semester, do not complete this form. Complete an Administrative Withdrawal Request Form instead.
Student Name

First NameLast Name
LoLA/Banner ID:
Student Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Birth Date

MonthDayYear
Date
Semester
Program/Major
Course Information
Signature
Date

MonthDayYear
Date
Student Comments
To be completed by the Registrar
Registrar Comments
Reviewed or Processed By:

First NameLast Name
Date Processed:

MonthDayYear
Date
Should be Empty:

To be completed by the Registrar