Student Initiated Withdrawal Form

Withdrawal Form

Use this form to withdraw from courses you are currently registered and enrolled in. For dropping or adding a course, contact your Advisor.
Students must read and acknowledge the following statement: Changes to your course schedule may impact the amount of aid received and eligibility for aid/benefits both this semester and in future semesters. Financial Aid and Veterans benefits recipients should discuss the consequences of changing your course schedule with the Financial Aid or Veterans Office before doing so. For additional information, review the ACC College Catalog.
Withdrawal Policy:

Each semester, a drop/add period for enrolled students to change their schedules begins on the first day of class and extends for a designated period of time (see Drop/Add Period above). A 75% tuition refund will be awarded for dropped courses through the 10 percent point of the course. Check the ACC Calendar for more information.

A student may withdraw from a course after the drop/add period and up until the 80% point of the course. After the 80 percent point of the course, the student’s final grade will reflect the earned numerical average of his/her work in the course. Students who have formally dropped a course may not continue attending those classes. Note: An instructor may drop a student from a course for excessive absences.

Student Instructions:

Before You Begin
Log in to Self-Service to confirm the courses you are currently registered for. After identifying the course(s) you wish to withdraw from, complete all required fields in this form.

Once submitted, your request will be routed to your Advisor and Instructor(s) for review. They may contact you to discuss your decision and ensure you have the information needed to make an informed choice.

Important:
If you are using Financial Aid or Veterans Benefits, please contact those offices before submitting this form to understand how withdrawing may affect your eligibility and funding.
Name

First NameMiddle NameLast Name
Student ID
ACC Email
aotter123@alamancecc.edu
Year
Which semester are you withdrawing from classes
Indicate if you want to withdraw from all courses or select courses.

The request will be sent to your Advisor and Instructor(s) for review before the request can be approved. You will be emailed a confirmation once the withdrawal has been fully processed.
Proceed to submit

Staff Instructions:

Review the submitted form, then add the appropriate instructor email(s) in the fields provided. Click SEND to route the request to the instructor(s) for the specified course(s).

Advisor: Once the form is routed back to you, contact the student to confirm they wish to proceed with the withdrawal, ensure they understand the potential impacts, and verify they have all necessary information to make an informed decision.
Advisor Email
aotter123@alamancecc.edu
Advisor Email (if more than one assigned)
aotter123@alamancecc.edu
Instructor Email #1
aotter123@alamancecc.edu
Instructor Email #2
aotter123@alamancecc.edu
Instructor Email #3
aotter123@alamancecc.edu
Instructor Email #4
aotter123@alamancecc.edu
Instructor Email #5
aotter123@alamancecc.edu
Staff: Determine Next Steps

Instructor Instructions:

Instructor(s): Review the submitted form and note the student’s status (e.g., current grade or other concerns). If outreach or intervention is appropriate, please use the student’s contact information in Watermark to connect with them by phone or email.
Date
Instructor Comments & LDA
Date
Instructor Comments & LDA
Date
Instructor Comments & LDA
Date
Instructor Comments & LDA
Date
Instructor Comments & LDA

Advisor Comments
Advisor: Approve or Stop the Withdrawal
Should be Empty: