Graduate and Certificate Course Withdrawal Form
*Please note that a withdrawal may affect a student's federal financial aid.
Name
*
First Name
Last Name
Student ID
*
Email
example@example.com
Preferred Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Current Program
*
Please Select
Certificate Program
Graduate Degree Program
Current Certificate Program
Please Select
Photonics and Optics
DEI - Non Licensure
Digital Marketing
Current Graduate Program
Please Select
Data Analytics
Inclusive Education
Marketing
Semester
*
Please Select
Spring 2026
Summer 2026
Fall 2026
CRN
*
Course #
*
Course Title
*
# of Credits Currently Enrolled
*
# of Credits Withdrawing
*
# of Credits Remaining
*
Reason for Withdrawal:
*
Please sign this form by providing your full name
*
Submit
Should be Empty: