Official Course Withdrawal

Student Name(Required)
First and Last Name
Student ID Number(Required)
(Do NOT enter SSN)
Student Email Address(Required)
Instructor Name(Required)
Instructor Email(Required)
Office Phone Number(Required)
Course Number and Section(Required)
Last date of attendance(Required)
MM slash DD slash YYYY
How did you contact this student to discuss course standing?(Required)
When did you last contact this student?(Required)
MM slash DD slash YYYY
Reason for course withdrawal(Required)
Withdrawal Grade(Required)
Select WP or WF only after last day to withdraw
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Withdrawals due to coronavirus

Check this box if the reason for this request is related to the coronavirus (COVID-19).
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Withdrawals due to coronavirus
- Check this box if the reason for this request is related to the coronavirus (COVID-19).
This field is hidden when viewing the form
Withdrawal Grade - Archive
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