Course Withdrawal Pass or Fail Form – River Valley Community College

River Valley Community College > Current Students > Registrar’s Office > Course Withdrawal Pass or Fail Form

This form is to process a student initiated withdrawal from a course after the withdrawal deadline (60%) of the course. If the student has a passing grade at the time of withdrawal, as determined by the instructor, the student is issued a Withdraw Passing mark (WP). “WP” does not affect GPA. If the student has a failing grade at time of the withdrawal, as determined by the instructor the student is issued a Withdraw Failing mark (WF). “WF” is calculated in the GPA as an “F”. WP or WF is noted on the student’s transcript.
Semester, Year*
Student ID#
Name*
First Middle Last
Email Address*
Phone Number*
Program of Study*
Course(s) I am withdrawing from (after the 60% point), a separate form must be done for each instructor:*
CRN Course Number Course Section Course Title Instructor Credits
TO THE STUDENT: We recommend that you consult with your Advisor and the Financial Aid Office before withdrawing from a course. Please submit this form to your instructor. It is the student’s responsibility to submit the completed form before the end of the course for processing. Please refer to the Refund/Withdrawal Policy for the applicable semester for dates and information. You can confirm the form has been processed by checking your SIS.

I understand by registering for courses at RVCC, I am financially obligated for ALL costs related to the registered course(s). Upon a drop or withdrawal, I understand that I will be responsible for all charges as noted in the student catalog and handbook. I further understand that if I do not make payment in full, my account may be reported to the credit bureau and/or turned over to an outside collection agency. I also understand that I will be responsible for the costs of the outside collection agency, any legal fees, and any bounced check fees under RSA 6:11, which will add significant costs to my account balance.
Student Signature*
Date*
MM slash DD slash YYYY

CRN	Course Number	Course Section	Course Title	Instructor	Credits