Complete Withdrawal Request Form

Complete this form to notify Enrollment Services in writing that you wish to drop your only class or all classes for the specified semester.

Name * First Last
Student ID or SS# *
Date of Birth * / MM / DD YYYY
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *
Semester *
Please list the classes you wish to be withdrawn from. *

(List all classes if known, you do not know the names of your classes, write “All Classes”) Example: ENGL 1010 01 English Composition I
What is your reason for Complete Withdrawal?
By signing this Complete Withdrawal Request Form I understand:
I will be removed from ALL of my classes and I will receive a W grade when withdrawal forms submitted after the census date (5th day for summer and 10th day of semester for fall and spring). *
I Understand
I may be required to pay financial aid back to Casper College. I may be ineligible for financial aid in the future. Dropping or withdrawing from college may affect my current and future financial aid awards; including but not limited to: PELL, Loans, Scholarships, Veterans Education Benefits, etc. *
I Understand
I will complete “EXIT COUNSELING” if I received a federal Stafford loan. I will go to www.caspercollege.edu/financial_aid to complete the Exit Counseling. I understand that Exit counseling will explain the terms of re-payment from my lender. I understand that repayment of loans will begin within six months of separation from school. *
I Agree
My eligibility to retain insurance coverage as a “student” can be affected. *
I Understand
Additional charges may result from this change or a balance due may remain after a complete withdrawal. I can receive billing statements for these charges at the address or email indicated above. *
I Understand
Draw your signature into the box below.

Clear
Please call Enrollment Services at 307-268-2323 if you have questions about the withdrawal process.

Complete Withdrawal Request Form

Complete Withdrawal Request Form

By signing this Complete Withdrawal Request Form I understand: