Withdrawal from College – River Valley Community College

Completion of this form documents my intent to withdraw from the College. Any official withdrawal from the College after the last date to withdraw from a full-semester course (with a “W” grade) has passed shall be considered effective the first day of the following semester for academic reasons, and the student will be held academically accountable for the entire semester. Students who have officially withdrawn from the College may apply for readmission.
Student ID#
Name
Last First Middle
Address
Street Address Address Line 2 City State ZIP Code
Email
Telephone #
Academic Program(s)
Semester
Year
Please list below any courses in which you are currently registered:
TERM CRN# COURSE NUMBER SECTION COURSE TITLE CREDITS
Reason(s) for Withdrawal
- Financial
- Work
- Health
- Relocating
- Personal
- Transferring to Another College
- Other
To which college are you transferring?
Student Signature

TERM	CRN#	COURSE NUMBER	SECTION	COURSE TITLE	CREDITS