CENTRAL TEXAS COLLEGE
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Student Application for Withdrawal
_________________________________
Date Received in Records Office
Student ID # _________________________________
_________________________________
Date Processed / By Whom
Student Name: ________________________
Last
First
M.I.
Course: ______________________________________
Synonym
Name
Number
Term: _______
Section
Year: _____
Reason for Withdrawing (&KHFN One) TEC 51.907 Course Withdrawal Limit Policy
WA - Academic
AW – Administrative
DW – Disability
SF – Sick/Care
WC – Deceased (Student)
WO - Other
WH – Church Mission
MW – Military
WD – Discipline
WS - Sick/Student
WM – Joined Military
WP – Peace Corps/ Foreign Aid
WF – Financial
WB – Textbooks
WV – Voluntary
** WG – Good Cause **
WE – Employment
WX –Non Military Move
DF – Deceased Family
WT – Temporary
** Documentation Required**
Instructor or administrative withdrawal for excessive absences or TSI non-compliance (Circle One) W FN XN
Number of Absences _________________ Date of Last Attendance: Month ______ Day ______ Year ______
Instructor or administrative withdrawal for scholastic dishonesty. F
* XN applies to developmental courses and Skills Center self-paced courses.
I have read the rules governing the official withdrawal policy as outlined in the current CTC Catalog, and I find it necessary to apply for
withdrawal from class. *Only instructor initiated withdrawals require the instructor’s signature.*
___________________________
_____________________________
Student’s Signature
* Instructor/Counselor Signature
______________________
Date
OFFICE USE ONLY
Student initiated withdrawal prior to published deadline W
Financial Aid Type:
TA
VA
FA
Ot her
None
CTC Form 59 (Rev 5/10) Copy 1 (white) Campus Business Office
Reset Form
(Check One)
Student initiated withdrawal after published deadline FN
Copy 2 (canary) Campus Records Office
PC ___________
Copy 3 (pink) Student
Date _____________
Copy 4 (goldenrod) Education Center
Submit