Western Texas College

Administrative/Instructor Drop Request

COMPLETE ALL FIELDS BELOW:

Date:

Student ID:

Last Name:

First Name:

Course Information:

Course Number:

Section

Semester

Year

Instructor:

Grade:

Last Date of Attendance:

I hereby request that the above named student be dropped from this class for the following reason:

Disciplinary reason(s).

Failure to complete multiple assignments and unlikely to pass the course.

Excessive absences (six hours or more of instruction during the semester)

How many classes?

Other:

Methods of contact or intervention with this student attempted:

Instructor Signature:*

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