Student Withdrawal Form

* required

Date	September 27, 2023
*Instructor Name
*Course ID and Section Number
*Student Last Name
*Student First Name
*Student ID (do not use SS#, as this is not encrypted)








*Initiated By	, For student initiated withdrawals, enter the date the student initiated the withdrawal. For faculty initiated withdrawals, enter the last date of attendance. For VP initiated withdrawals, enter the date the withdrawal was initiated (or whatever the wording is there).




*Faculty signature by entering your email and Colleague ID below, you are authorizing this student to be withdrawn.	Email: Colleague ID:
Reason for withdrawal (if given) Select the primary reason.
	Approved official withdrawals through the 12th week of a regular semester (Sixth week of summer) will automatically be assigned a grade of W. No withdrawals are allowed after this date.