Total Withdrawal Form Summer 2023

This form is to be used to submit a request to be withdrawn from ALL courses in which you are currently enrolled. If you only need to withdraw from an individual course(s), you must do so through your OneACCS student account.
If you are a Pell student or receiving a student loan and have not communicated with a financial aid advisor, please do so before continuing. This withdrawal form will be disabled at midnight on the evening of the withdrawal deadline. Your withdrawal will be processed based on the automatic date stamp. Withdrawal requests submitted after the withdrawal deadline for the term will NOT be processed and you will receive the grade earned in the course.
If you are a Dual Enrollment student, you must use the withdrawal form located on the Dual Enrollment webpage.

WITHDRAWAL DEADLINES FOR Summer 2023:
Term I - June 23, 2023
Term II and Full Term - August 1, 2023

Withdrawal Survey

(Must be completed prior to submitting withdrawal)

First Name

Last Name

CA Student ID Number (A #)

CA Email Address

Example: abc5019@student.coastalalabama.edu

Are you the recipient of a Pell or other educational grant?

Are you receiving a direct or other student loan?

Are you on the college work-study program?

Are you a military veteran or dependent receiving VA benefits?

Are you the recipient of a scholarship?

Do you live in a Coastal Alabama residence hall?

If yes, and you are dropping below the required 12 semester hours, you MUST see the Housing Office PRIOR to submitting a withdrawal request. If you are completely withdrawing from all classes, release from the residence hall contract will require approval from the Housing Office.

Are you a student athlete?

Student athletes MUST have permission to withdraw from their coach and MUST remain enrolled in 12 semester hours to remain eligible for play.

Are you a dual enrollment student (taking college classes while still in high school)?

Have you discussed this withdrawal with your advisor to determine the impact on your time towards completing your academic goals?

Have you discussed this withdrawal with a representative in the Financial Aid Office?

Is there anything the College could have done differently to help you meet your goals or to help you prior to your decision to withdraw? If so, please provide comments below:

If you could change one thing at Coastal Alabama to improve your learning experience, what would it be?

Please select which offices you feel have been most helpful with your college experience at Coastal Alabama:

Student Development

Admissions

Financial Aid

Student Support Services

Faculty

Other offices that have been helpful with my college experience at Coastal Alabama:

How satisfied are you with your experience at Coastal Alabama Community College? (rate 1 to 5 with 1 being Very Dissatisfied to 5 being Very Satisfied)

I have read and understand the withdrawal policy, the Return of Title IV Aid Policy, and the Refund Policy.

Yes

What is your reason for withdrawal from Coastal Alabama?

Please list other reason(s) for withdrawal here:

Have you discussed the need to withdraw with your instructor(s)?

If you answered NO to the above question, please explain why you have not discussed this matter with your instructor(s):

Please confirm the following:

I authorize Coastal Alabama Community College to officially withdraw me from ALL CLASSES in which I am currently enrolled.

Enter your name and check the box below to indicate your signature

Check the box below to indicate your signature

Checking this box indicates my signature