Paul D. Camp Community College – Student Withdrawal Form

Student Withdrawal Form

Complete all fields below. List each course you wish to withdraw from in the table, including the class number, subject, catalog number, section, campus, and credits. Check Lab (L) or Audit (X) if applicable. Sign and provide your reason for withdrawal. Click Print to PDF, choose Save as PDF, and email the completed form to the Office of Admissions.

* Indicates a required field.

Student Information

Student Name

Emplid ID

Date

Semester

Class Number	Subject	Catalog No.	Section	Campus	Lab (L)	Audit (X)	Day and Time	Credits






Total Credits Dropped

Student Declaration

Student Signature

Reason for Withdrawal from Course(s)

For Office of Admissions Use Only

Dean Financial Aid Advisor / Counselor Instructor

Signature: Date:

STUDENT WITHDRAWAL FORM | 1/2020

When the print dialog opens, choose Save as PDF as the destination.