Online Withdrawal Request
  1. First Name(*)
    First Name required.
  2. Middle Name
    Invalid Input
  3. Last Name(*)
    Last Name required.
  4. ECC Student ID(*)
    (7 Digits)
    Invalid Input
  5. Birth Date
    (in form of 01/01/1981)
    Invalid Input
  6. Home Address
    Please let us know your message.
  7. Your Email(*)
    (MyEdge Email Address)
    Request will fail if email address is not given!
  8. Phone(*)
    (including area code)
    This number may be called to verify request, it is required.
  9. Best time to call
    Invalid Input
  10. List the Courses You Wish to Withdraw From
    Course Prefix
    (ex: ENG)
    Number
    (ex: 111)
    Section
    (ex: OL1)
    Course Title
    Instructor Name
    Ever Attended?
  11. At least one course listing is required for this form.
    At least one course listing is required for this form.
    At least one course listing is required for this form.
    At least one course listing is required for this form.
    Invalid Input
    Invalid Input
  12. Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
  13. Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
  14. Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
  15. Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
    Invalid Input
  16. Reason for Request
    Invalid Input
  17. Your Program of Study
    Invalid Input
  18. Name of your advisor
    Invalid Input
  19. Please enter the captcha phrase. If you cannot read the phrase, click on the refresh button below the captcha for a new set of characters.
    Please enter the captcha phrase. If you cannot read the phrase, click on the refresh button below the captcha for a new set of characters.
      RefreshInvalid Input