Student Course Withdrawal Request

First Name(Required)

Middle Name

Last Name(Required)

Student ID Number(Required)

Do not use your social security number

Email(Required)

Home Address(Required)

Phone Number(Required)

Course Prefix(Required)

Course Number(Required)

Course Section(Required)

Course Title(Required)

Instructor(Required)

Attended(Required)

Name of your Advisor(Required)

Your program of study(Required)

Program of study

Please enter your program of study if it is not included in the above list.

Reason for request(Required)

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Requests due to coronavirus

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Requests due to coronavirus

Please check this box if the reason for your request is related to the coronavirus (COVID-19).

Financial Aid Confirmation

I have spoken with the Financial Aid office, and understand that withdrawing from this class could impact my financial aid and/or result in a balance owed to Edgecombe Community College.

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Student Portal Forms