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PACE Withdrawal Form
Name (First and Last)
CBC ID #
Date Format: MM slash DD slash YYYY
Withdraw me from ONE course
Withdraw me from ALL courses for the current semester
Withdraw me from the following courses
Reason for withdrawal. Select one.
Intent to Return
I intend to return to class in a future block based on my course registration.
I do not intend to return during this semester.
I plan to return in the following semester
Intent to Return Statement
I understand that the date of my intended return must be within 45 days of my date of withdrawal in order for my federal aid to remain in effect for the semester. I understand my aid may be reduced because of the reduction in credit hours take. I understand if I do not return as indicated, I will be considered to have withdrawn from the entire semester, and this could drastically reduce or eliminate the amount of federal aid I have been awarded. I understand if I need to change my date of return, I must do so before the original date of return. I understand the completion of this form is a requirement of the U.S. Department of Education.
Acknowledgement of Intent to Return Statement
I acknowledge that I have read and agree to the statement above.
VA Benefits: It is your responsibility to contact Lori Lee at firstname.lastname@example.org if you are receiving VA Benefits.
Withdrawal Course Fees
I understand that upon my withdrawal the course fee may or may not be refunded.
I understand that a grade will be determined and recorded by the Registrar's office following the guidelines listed below:
Up to the close of business the day of the first class meeting - Removed from transcript. (Full tuition reversal. Course fee refunded)
After the 1st class meeting and before the 2nd class meeting - "W" (50% tuition reversal. course fee non-refundable.)
After the 2nd class meeting and before the 4th class meeting - "W" (No tuition reversal. Course fee non-refundable)
After the 4th class meeting and before the 5th class meeting - "WP" or "WF" assigned by instructor. (No tuition reversal. Course fee non-refundable.)
Online Withdrawal Guidelines:
Up to the start of the course - Removed from transcript (Full tuition reversal. Course fee refunded)
Up to day 7 of the course - "W" (50% tuition reversal. Course fee non-refundable.)
Days 8 - 14 of the course - "W" (No tuition reversal. Course fee non-refundable.)
After day 14 of the course - "WP" or "WF" will be assigned by instructor. (No tuition reversal. Course fee non-refundable.)
For Office Use Only FA - BO - VA - Reg - IT - Instr -
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PACE Chapel 2019
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