MSVCC WITHDRAWAL FORM

Student Name - First:   Last:  

Co-Lin Student ID:               

Campus: Wesson  Natchez Simpson County

Phone:

Course Number:         (Example: CPT1213)   Section Number:

College Where Course is Offered:   

* Complete this section only if you selected Copiah-Lincoln Community College from the drop-down list above.
Course Instructor:          * Emails this Instructor 


Other Email:                 * Key in if Instructor is not listed above, otherwise leave blank
                                                                                              (use the format "first.last@colin.edu")