Instructor Initiated Withdrawal Form
Instructor Withdrawals DO NOT initiate a refund for the student
Student Last Name:
Subject Identifier ie: ENG
Last Date Attended
If never attended, add 0 to
A value is required.
Select One of the following codes
for explanation of drop:
If you have entered 0's in the dates of attendance fields, be sure to select the
NA_Never Attended option from the drop down menu below.
DII_Disatisfied_ with_ Instructor
DIS_Disatisfied_ with_ Service
IF_Insufficient Financial Aid
LI_Lack of Interest
MEG_Met Educational Goal
MWG_Met Work Goal
MATC is an Affirmative Action/Equal
Opportunity Institution and complies with all requirements of the Americans
with Disabilities Act.
An email with a copy of the text on this form has been sent to the address you entered on the form. You may also want to print a copy of this form before you click submit.