Return your completed form to:
Secured Fax: 719-255-3911
Mail:
Campus Wide Extended Studies
1420 Austin Bluffs Parkway
Colorado Springs, CO 80918
In-Person: Campus Wide Extended Studies (across the street from UCCS campus)
1861 Austin Bluffs Parkway, Ste. 100 (University Office Park)
Questions: cwes@uccs.edu, 719-255-3498, www.uccs.edu/extendedstudies
ADD * DROP/WITHDRAWAL Request
Year
Student ID #
Semester:
Spring
Last Name
Summer
Email Address
Daytime Phone
Fall
First Name
Middle Name
Former Name, if applicable
Date of Birth
I wish to ADD the following course(s):
TITLE OF COURSE
COURSE # (ex: MATH 1050
Sec 701)
5-digit Class Nbr #
START DATE
ADD
Payment Method (please mark one):
Check/Money Order #_________
VISA
MASTER CARD
Print name as it appears on Credit Card
Total amount paid
Signature
Credit Card Number
AMERICAN EXPRESS
Discover
Exp. Date
I wish to DROP/WITHDRAW from the following course (If past the course census date, a grade of ‘W’ will be recorded on your transcript):
DROP
TITLE OF COURSE
COURSE #
SEC #
CREDIT HRS
START DATE
or
WITHDRAW
(if past census date)
Required
Signature
Have you received an award from the UCCS Financial Aid Office? ___No
___Yes
(For Withdrawals only)
Are you receiving benefits from VA? ___No ___Yes
Instructor Signature:____________________________Date:__________
Was your tuition paid by a third party? ___No ___Yes
Dean’s Signature:_______________________________Date:__________
I understand that it is my responsibility to know the regulations of the school or college concerning add/drop/withdrawal enrollment and I accept
full academic and financial responsibility for each add/drop/withdrawal. Changes are not official until form is complete and received by CWES.
STUDENT’S SIGNATURE:________________________________________________________DATE:__________________________
(FOR OFFICE USE) Date Completed_________
AMOUNT TO REFUND, IF ANY: $________________
ES COORDINATOR SIGNATURE:_______________________________ DATE:______________
updated 2/2012