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Administrative/Instructor Drop Request
COMPLETE ALL FIELDS BELOW:
Date:
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Student ID:
Last Name:
First Name:
M:
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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