CARE Withdrawl Form

Name(Required)

First Last

Student ID Number(Required)

Email(Required)

Phone(Required)

Are you a current high school student participating in Dual Enrollment?(Required)

Yes

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 Courses withdrawn with the grade of W assigned will still need to be paid for by Dual Enrollment funding.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(Required)

Semester(Required)

Year(Required)

Cousre Information

Please enter information for the courses you would like to be withdrawn from:

Course Reference Numbers (CRN)(Required)

List CRNs for ALL courses you are requesting to be withdrawn from:

Course Abbreviation and Numbers(Required)

List the course abbreviation and numbers for ALL courses you are requesting to be withdrawn from i.e. ENGL 1101, MATH 1111: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

Low course grade(s)

My own medical/Illness

Family medical/Illness

Work schedule conflict

Moving/relocation

Other

Please check the appropriate box(es) below to indicate the reason for your withdrawal:

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?(Required)

Acknowledgement and Consent

Please initial the box below: I understand that withdrawing from a class or classes can negatively affect my financial aid eligibilty.(Required)

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.(Required)

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.(Required)

Student Signature(Required)

Please sign below.