OFFICE OF THE REGISTRAR
Brown Hall, Suite 307
Student ID Number
A FFIDAVIT FOR N ON-A TTENDANCE
Date
T __ __ __ __ __ __ __ __
Name Enrolled Under (Last, First, Middle, Other)
Term/ Year
Spring
Summer
Fall
Phone Number
Student Signature
of 20___
___ ___ ___ - ___ ___ ___ - ___ ___ ___ ___
In order to be dropped for Non-Attendance with 100% reduction of tuition/fees, this form must be completed
by the instructor(s) of the course(s) for which you did not attend, and returned to the Registrar’s Office by
the end of the third week of class for Fall/Spring and first week for each Summer session.
I, instructor of the course(s) below, confirm that for the semester specified above this student DID NOT attend ANY
classes during the term:
CRN
Course
Course
Sect.
Prefix
No.
No.
Instructor’s Printed Name
Instructor’s Signature
Date of
Signature
Revised May 8, 2012