Student Request for

A Diverse Learning Community | An Equal Access/Equal Opportunity College

Withdrawal
IMPORTANT NOTICE TO STUDENT:
The College recognizes that there may be many reasons which have influenced your decision to withdraw
from a course this term. You should be aware, however, that withdrawal could affect your standards of
academic progress or any financial aid awards or other benefits you might be receiving.
If you are an international student, you need to check with an International Student Advisor prior to with-
drawal from a course as this could affect your Visa status.
You must submit this form to Student Success Services by the deadline published in the College catalog.

PLEASE COMPLETE: Term:___________________ Date:______________________

Name ________________________________________________ Student I.D. # ____________________

Please Print Last First MI

Check One: o College Credit o Vocational o Adult High School o Adult Education
o Community/Continuing Ed o Other ________________________

If you are receiving financial assistance or benefits, your withdrawal must be signed by the Financial
Aid Office or VA Office prior to withdrawal.
_______________________________________________
Financial Aid Office
Students who have received previous or current Federal Student Loans are required to contact their lenders
of the enrollment status and are also required to complete Loan Exit Counseling. Exit counseling can be
completed on-line through the College Homepage financial aid links. Students wishing to complete exit
counseling by a means other than on-line, should contact the Seminole State College Financial Aid office
for alternative methods to complete this requirement.

Course Name_________________________________ ______________________________

Subject/Catalog # & Class/Section #

Course Name_________________________________ ______________________________

Subject/Catalog # & Class/Section #

Course Name_________________________________ ______________________________

Subject/Catalog # & Class/Section #

Course Name _______________________________ ______________________________

Subject/Catalog # & Class/Section #

Course Name _______________________________ ______________________________

Subject/Catalog # & Class/Section #

By your signature, you are agreeing that you have read and understand the information printed on the
back of this form.

______________ ___________________________________ _________________

Operator’s Initials Student’s Signature Date

100 Weldon Boulevard, Sanford, FL 32773-6199

White copy - Registration Yellow copy - Financial Aid Pink copy - Student
259746 Rev. 8-2012
Your signature at the bottom of the Withdrawal Form indicates that you have read and
understood the following information:

1. Any Federal financial aid recipient who completely withdraws or ceases attendance prior to completing
more than 60 percent of any given term will be required to repay all or a percentage of the aid received.
Students who find themselves in a situation where they must withdraw should make an effort to
pass at least one course. In addition, the last date of attendance for withdrawn course(s) must be
documented in order to minimize any overpayment/repayment of Federal funds. Failure to repay or
make arrangements to repay these funds will make you ineligible for future Federal Assistance from
the College or any other institutions. The Department of Education has not made any provisions for
extenuating circumstances. There is no appeals process.

2. Scholarships typically require full-time status.

3. VA Benefits: Students receiving Veterans’ Benefits are required to pay back a portion of the benefits
if they withdraw from a class. If the student withdraws from all classes, all benefits for the term must
be returned.

4. Typically, insurance premiums are increased if the student drops below full-time status.

5. Often, students entering the military must show good grades in full-time status during the semester
before entry.

6. International students must remain full-time for INS and VISA status to remain at the College. See the
International Student Advisor.

7. Withdrawals affect the student’s Academic Standards of Progress: Students withdrawing from more
than 50 percent of the credits they attempted are placed into a “Warning” status. If student again
fails to successfully complete 50 percent of credits attempted, the student is placed on “Probation,”
subsequently “Suspension,” and then “Dismissal.”

8. Per Department of Education Board Rule 6A-14.0301:

a. Withdrawals count toward the total attempts. If the student withdraws after the second
attempt, the full cost of the tuition (equivalent to out-of-state tuition) must be paid.
b. A student may not withdraw from a course on the third attempt. Students must be given a
grade in the course on the third attempt.
c. Students must complete the formal petition process if requesting to attempt a course for
the fourth time.

259746 Rev. 8-2012