Student Drop and Withdrawal Form

Student Drop and Withdrawal Form
This from should be used when a student needs assistance with dropping or withdrawing from a course.
- A drop will be processed when this form is submitted before the end of the semester or session's add/drop period.
- A withdrawal will be processed when this form is submitted after the add/drop period, but before the last day to withdraw from a course.
Student Name*

First NameLast Name
LoLA/Banner ID:*
Student Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Birth Date*

MonthDayYear
Date
Semester*
Program/Major*
Course Information*
Signature*

Clear
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