ࡱ> Y[XQ ,bjbj B3tete 777KKK8D,K0& !!!///////$2}5>0E7!!!"!!0 [0W%W%W%!^ 8 /W%!/W%W%V-@- p41qhW"^X- /q000d-x5"Z5--857.!!W%!!!!!00$H!!!0!!!!5!!!!!!!!! :  Class Withdrawal/Drop Form Name_______________________________________________________________________________ Semester________________ Academic Year _____________ Program _______________________ Address: ____________________________________________________________________________ ____________________________________________________________________________________ Phone Number: _________________________________________________________________ Email Address: _________________________________________________________________ Definitions: Dropping a class(es): Dropping a class(es) during the full or partial tuition refund time frame. Dropped classes are completely removed from the students transcript. Withdrawing from a class(es): After the final drop date, students may withdraw from class(es), through the final day to withdraw. A grade of W will be noted on a students transcript for each withdrawn class. There is no tuition refund for withdrawn classes. Drop and withdraw dates are noted on the Academic Calendar ( HYPERLINK "/student-services/office-of-the-registrar/academic-calendar/" /student-services/office-of-the-registrar/academic-calendar/). *If withdrawing or dropping all courses for the semester, please complete the Semester Withdrawal/Drop Form I am officially dropping or withdrawing from the following class(es): ____________________________________________________________________________ ____________________________________________________________________________ Is drop or withdraw due to (check one): n Academic n Non-Academic If non-academic (check one): n Financial n Health n Family n Personal n Other: __________________________________________________________ Review and initial next to each of the following statements. ____ I understand the terms and conditions of my drop or withdrawal. ____ I understand that, if applicable, I need to meet with the Director of Clinical Training to discuss any implications of dropping or withdrawing from practicum or internship and any steps needed to move forward. ____ I understand that if I am receiving financial aid that I should consult with the Director of Financial Aid to determine the impact of a drop or a withdraw on my award and repayment. ____ I understand that all tuition, fees, and any other outstanding balances owed to will be deducted from any refund owed me. ____ I understand that I am responsible for checking my account in Empower to determine any outstanding balances owed. 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