CARE Withdrawl Form

Withdrawal Form

Regular and punctual attendance at all scheduled classes is an essential aspect of student success. Students will be expected to complete all work required by the instructor as described in each course syllabus. Students who stop participating in class, but do not formally withdraw, may receive a grade of F and face financial aid repercussions in upcoming semesters. Students will not be withdrawn by an instructor for attendance; however, all instructors will keep records of graded assignments and student participation in course activities. The completion dates of these activities may be used to determine a student’s last date of participation in the event a student withdraws, stops attending, or receives an F in a course.

Name*
First Last
Student ID Number*
Email*
Phone*
Are you a current high school student participating in Dual Enrollment?*
- Yes
- No
High school students become ineligible to receive Dual Enrollment funding for future terms after their 2nd course withdrawal (W). Courses withdrawn with the grade of W assigned will still need to be paid for by Dual Enrollment funding. A high school student may not receive Dual Enrollment funding for the same course twice. W – This grade signifies that a student withdrew from a CTC course prior to the end of the term. No credit is given, and no grade points are calculated. A grade of “W” is not included in calculating the college grade point average but is counted as coursework attempted.
Withdrawal Type*
Semester*
Year*
Course Information
Please enter information for the courses you would like to be withdrawn from:
Course Reference Numbers (CRN)*
List CRNs for ALL courses you are requesting to be withdrawn from:
Course Abbreviation and Numbers*
List the course abbreviation and numbers for ALL courses you are requesting to be withdrawn from i.e. ENGL 1101, MATH 1111:
Reason for Withdrawal*
Please check the appropriate box(es) below to indicate the reason for your withdrawal:
- Low course grade(s)
- My own medical/Illness
- Family medical/Illness
- Work schedule conflict
- Moving/relocation
- Other
Other/Additional Detail for Withdrawal
Please provide additional detail of your reason for withdrawal or if your withdrawal reason is not listed.
Do you intend to take classes at CTC next semester or in the future?*
Acknowledgement and Consent
Please initial the box below: I understand that withdrawing from a class or classes can negatively affect my financial aid eligibilty.*
Please initial the box below: I understand that withdrawing from a class or classes (either before or after the W deadline) counts as credit hours attempted but not completed when determining financial aid eligibility according to SAP procedure.*
Please initial the box below: I understand that if I have federal financial aid (Pell Grant, FSEOG) and totally withdraw from all courses on my schedule that my financial aid will be recalculated according to the percentage of the semester that I completed according to federal law (Return to Title IV). This may result in owing a balance to the college in which I must repay unearned financial aid funds*
Please initial the box below: I understand that if I am a Dual Enrollment student it is my responsibility to inform my high school and to find out how my high school graduation path may be affected.*
Student Signature*
Please sign below.

Withdrawal Form

Course Information

Acknowledgement and Consent