Withdrawal Form Step Step Type of Withdrawal Partial Complete Student ID # * Full Name * First Name Last Name Semester * Choose one Spring Summer Fall Please select your student classification First Time Freshman Returning Student Transient Dual Enrollment Course Number Section Number Course Name Credit Hours NOTE: Students who withdraw from a course will receive a grade of “W” provided this form is completed and returned to Student Services by the “last day to withdraw from a class” date. There is NO refund due to a student who partially withdraws after the official drop/add period. If you receive any aid, please check the corresponding box(s): VA benefits Pell Grant Scholarship Direct Loans Athletic Scholarship None Reason(s) for withdrawal * Please select all that apply Decide to attend another college Unhappy with my grades Health-related problem (personal or family) Courses were too difficult Moving to a new location Courses were not challenging Transportation difficulties Dissatisfied with academic advising Child care not available or too costly Dissatisfied with quality of instruction Family responsibilities Class scheduling problems Accepted a full-time job Impersonal faculty or staff Unable to obtain financial aid Faculty were unavailable for assistance Encountered unexpected expenses Conflict between work and class schedules Do you plan to return to CACC in the future? * Do you plan to return to CACC in the future? Yes No Signature * Clear I have read and I understand the above statement and I wish to withdraw from the course(s) listed above. I understand that someone from one or more of the offices listed below may contact me via my CACC email regarding my withdrawal. By typing and or signing your name in the space below authorizes the withdrawal from the class or classes listed above.
