Student: Please complete the following information

First Name:

Last Name:

Student ID:

Major:

Semester:

Permanent address:

Zip:

City/Town:

State

University Email Address:

Telephone:

I am requesting permission to withdraw from the following course:

CRN

Subject (e.g. MAT)

Course Number (e.g. 501)

Section (e.g. 71)

Course Title

Credits

Days

Time

Note: Withdrawing from a course may result in a reduction of your financial award. If you are a veteran or a student receiving financial aid please consult with the Office of Student Financial Services before completing this form.

Students may withdraw from a full-semester course, without academic penalty, until the end of the tenth week of the semester. For eight week courses, it is the last day of the fifth week; for five week courses, it is the last day of the third week; for three week courses, it is the last day of the second week. Withdrawals are recorded on your transcript with a grade of “W.”

Reason for withdrawal:

By selecting the "I Accept" button, you are agreeing to sign this form electronically and that your typed signature is the legal equivalent of your manual signature. If applicable refunds will be applied according to the Cashier's website to review the refund policy go to https://www.wcsu.edu/cashiers/refund/. Online course refunds are calculated such that each day beginning with the first day of class is considered a class schedule. Course withdrawal forms are effective the date this form is electronically submitted.

I Accept

Student signature (typed):

Contact Information