Course Withdrawal Form

(Please complete this form and return to the Registrar’s Office)

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STUDENT’S NAME (Please print legibly)

Last _______________________________ First ____________________ Middle Initial _______

Clark ID # ___________________

Mail Box/Dept.________________________

CRN #

DEPT.

CRS #

SECT

COURSE TITLE

UNIT

You should realize that if, by dropping a course, you fall below the three-course minimum necessary to retain full-time status, you may be considered a part-time student by your health insurance carrier, the Immigration and Naturalization Service, or other external agencies. Furthermore, dropping below three courses may affect your eligibility for financial aid and your progress toward graduation. If you have any questions about your status, you should contact either the Academic Advising center or the Dean of Students Office BEFORE dropping your course. Graduate students should speak with their department chair.

Student’s Signature_____________________________________________Date_________________