Withdrawal Form

Name*

First Middle Last

Student ID*

Semester*

Year*

Program of Study*

Phone Number*

Are you withdrawing from all classes?*

Will you return next semester?*

Are you a Dual Enrollment Student?*

If you are withdrawing from all classes this semester, please indicate the most related reason below:*

How has COVID-19 directly affected your studies with Atlanta Technical College?

Please indicate employment status. If employed, please provide information below.*

Employer Name

Position

CRN	SUBJECT	SUBJECT	COURSE NAME	INSTRUCTOR