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Adult Workforce Education Withdrawal Form

Today’s Date:
	
Completed by:

Student Name:

Address:

Email:
	
Phone:

Program enrolled in:

Reason for withdrawal:

Last Date of Attendance:
	
Date of Withdrawal:

Student’s Signature:

For Office Use Only
	Days Attended
		Hours Attended
		
	Cost per Day
		Cost per Hour

Withdra Initials
	wal Form has been seen by: Date
Student Services
Adult Workforce Director Financial Aid Specialist Lori Smith (Reviewer)
AWE Administrative Assistant

New Payment Plan? (Y/N):
	Financial Information: Tuition
Student Fees Testing Fees Books Supplies Application Fee Other
Other Other
Subtotal

				

				

				

Financial Aid Adjustment

Subtotal

		

		

Student Responsibility	TOTAL

Student understands that this amount must be paid (Initials):

DLC – 2/14/2019