Noncredit Course Withdrawal Form

Please complete this form to withdraw/drop from one or more noncredit courses offered through SUNY Adirondack Continuing Education. This form can also be used to request a refund or bill adjustment when such a refund or bill adjustment would not normally be permitted based on the noncredit course drop/tuition liability policy. Please contact SUNY Adirondack Continuing Education at conted@sunyacc.edu with any questions.

Student name:*

Legal First NameMiddle NameLast Name

Banner ID (student ID number):

Email address:*

Phone number:*

Area CodePhone Number

Please list the noncredit course(s) from which you would like to withdraw:*

	CRN (Course Registration Number)	Course Title	Semester
Course 1
Course 2
Course 3

(Optional) If you would like to request a refund or bill adjustment, please explain your request here. IMPORTANT: If you drop a noncredit course after its tuition and/or materials fees liability deadlines have passed, you will still owe the applicable tuition or materials fees unless an exception is approved. Please note that such refunds or bill adjustment exceptions are not guaranteed to be granted.

By clicking the Submit button below, I confirm that I am withdrawing from the noncredit course(s) listed above, that all information provided is accurate and complete, and that all decisions are final. I understand that any refunds or bill adjustment requests might not be granted when dropping a course after the tuition and materials fees liability deadlines noted in the noncredit course drop/tuition liability policy have passed, and that if a refund or bill adjustment is not approved, I am responsible for any outstanding balance owed for the course(s) from which I dropped.