Withdrawal Form

Student Name

Parent Name

Email

example@example.com

Phone Number

Street Address

City, State, Zip

Indicate which applies:

Indicate the option that best describes your withdrawal

Title of Class (please list all classes that student is Withdrawing from and the day(s) the class(es) are held)

Last date of class attendance (if applicable)

MonthDayYear

Reason for Withdrawing

Email Address

Comment (if desired)

Once you submit this form, your account will be reconciled and you will be informed of the status of your account (ie. if there is a credit balance, etc.)

Withdrawal from classes is not official until you submit this form, and all credits will be calculated from the date this form is received.

WITHDRAWAL FORM