Request for Withdrawal

Name(Required)

First Last

Student ID #(Required)

Date of Birth(Required)

Advisor Name(Required)

Advisor Email(Required)

Please confirm that you have the correct KWC email for your advisor. You can double-check by selecting the advisor list below.

KWC Advisor List

Are you currently a member of a KWC sports program?(Required)

Yes

No

If so, which one:

Non-KWC email(Required)

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Cell phone # with Area Code

Withdrawal is to be effective:(Required)

Immediately

At the end of the current semester

Please state your reason for withdrawal:(Required)

Last date you attended any class at KWC:(Required)

May we contact you about your KWC experience?(Required)

Yes

No

Student Signature(Required)

Date(Required)