HTML Preview College Application Withdrawal Letter page number 1.
LATE WITHDRAWAL REQUEST
The late withdrawal process takes approximately four to six weeks. SUBMITTING A LATE WITHDRAWAL REQUEST
FORM DOES NOT OFFICIALLY WITHDRAW YOU FROM A CLASS OR THE COLLEGE. Decisions will be based on the
documentation provided. You will be notified in writing of the Appeals Committee’s decision.
Supporting documentation, as indicated below, MUST accompany late withdrawal requests based on a College action or a personal emergency.
Medical – a letter from your physician or health care agency, on company letterhead, specifically indicating an illness of such severity or
duration that prevents you from continuing in your course(s). The letter must include dates of the illness and treatment.
Employment – a letter from your employer, on company letterhead, indicating that your employer changed your work schedule and that
this change prevents you from completing the term. The letter must include old and new work hours and the effective date.
Death of Immediate Family Member – documentation of the death and your relationship to the deceased. Immediate family members are
limited to spouse, child, parent and sibling.
College Change or Error– a letter from the appropriate college official documenting the situation in which the college was in error or
initiated an action that caused you to have to withdraw.
____________________________________________________________________________
PLEASE PRINT Term: Fall Spring Summer Year _________
Location: Belle Glade Boca Raton Lake Worth Palm Beach Gardens
NAME _______________________________________ Student ID _______________________ Telephone # (______) ___________________
STREET_______________________________________________ CITY ________________________ STATE _______ ZIP _____________
LAST DAY OF ATTENDANCE: _________________________ (Instructor must send verification to Campus Registrar)
Are you receiving any of the following? If so, please be advised that a late withdrawal may affect your financial aid status. (Check all that
apply):
Pell Grant Student Loans PIC JTPA Veteran Affairs Scholarships Accounts Receivable
Are you an international student? Yes No If yes, contact your counselor as late withdrawal may affect immigration status.
COURSE(S) for which you are requesting a late withdrawal:
COURSE REFERENCE # COURSE TITLE Reason for request (documentation is required )
_______________________ ___________________________________________ ___MEDICAL
_______________________ ___________________________________________ ___EMPLOYMENT
_______________________ ___________________________________________ ___DEATH OF FAMILY MEMBER
_______________________ ___________________________________________ ___OTHER (SPECIFY BELOW)
JUSTIFICATION FOR REQUEST________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
SIGNATURE___________________________________________________ DATE_____________________
PLEASE READ CAREFULLY AND INITIAL WHERE INDICATED:
I AM NOT A FINANCIAL AID RECIPIENT.
I AM A FINANCIAL AID RECIPIENT AND UNDERSTAND THAT IF
THIS REQUEST IS GRANTED IT MAY IMPACT THE FINANCIAL
AID RECEIVED FOR THIS TERM AND/OR ANY FUTURE TERM IF
THE STANDARDS OF ACADEMIC PROGRESS ARE NOT MET.
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