Date:
Student Name:
Student ID: W00
Program/Major:
Term(check one):
Year: 20
Phone #:
Alternate Contact #:
Contact Email:

Are you dropping all courses?"

Reason for Drop/Withdrawal: Please check all that apply

CRN
Subject
Course #
Course Title
Credit Hrs

I understand that by dropping and/or withdrawing from classes at WSU Tech, I am required to pay any outstanding balances due on my account. My student balance statement is located in the student tab of MyWSU Tech.

Student's Signature:
Date: