MSVCC WITHDRAWAL FORM

Withdrawing from MSVCC class does not remove your responsibility to pay or your balance due.
If you are receiving aid, please contact the Financial Aid office before completing this form.

Student Name - First:   Last:  

Co-Lin Student ID:               

Campus: Wesson  Natchez Simpson County

Phone:    Reason for Withdrawal:

Course Number:         (Example: CPT1213)   Section Number:

College Where Course is Offered:   

COURSE INSTRUCTOR EMAILS:
Choose Instructor Type:
Co-Lin Instructor - Select Co-Lin Instructor Email:
      Wesson Campus                                                 Natchez Campus                                                      Simpson Campus
                           
Not a Co-Lin Instructor
Instructor Unknown
* If this is an Academic course and you are a Co-Lin Career-Tech student, select the Email address of your Advisor (if known), otherwise leave blank:
      Wesson Campus                                                 Natchez Campus                                                      Simpson Campus
                           

* PLEASE PRINT AND RETAIN THIS FORM FOR YOUR RECORDS *