SUNY ERIE OFFICIAL WITHDRAWAL FROM COURSE FORM ** Complete and Return Entire Form to the Registrar's Office ** Student Name Student I.D. Number Course Title (Name) Course Number (ex. EN 123) Course Section (ex. AB, 01, 0B, IC1) Semester/Year (ex. Fall ‘14) Campus Instructor Name STUDENT SIGNATURE
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PLEASE NOTE: Form must be returned within published deadlines to be accepted. Withdrawal from course(s) may affect Student Financial Aid. Contact the Financial Aid Office for further Information. WITHDRAWAL FROM COURSE DOES NOT RELEASE STUDENT FROM FINANCIAL LIABILITY. Office Use Only: Date Processed Rev. 10/20 RegC Forms.withdrawal.doc
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Distribution: White: Registrar
Yellow: Student