Course Administrative Withdrawal Form

Effective Date: October 9, 2025

Submission of this form will only serve as notification that you wish to administratively withdraw a student from a Dual Enrollment course(s). You will be contacted by an Embry-Riddle representative concerning the status of this request.

Student Information

ERAU Student ID: *

First Name: *

Last Name: *

Email: *

Dual Enrollment Location: *

Term Information

Term: *

From: *

To: *

Mid-Point: *

Course Information

Enter Course(s) you wish to withdraw from:

Item	Course ID	Title	Last Attended Date
1
2
3
4
5

Withdrawal without academic penalty is authorized up to Mid-Point of the first term within the HS semester. The effective date will be the date the HS dual enrollment counselor submits the Course Withdrawal form on behalf of the student. The effective date is October 9, 2025.

If the effective date exceeds the midpoint of the first term within the HS semester DO NOT use this form.

Refunds, if applicable, are based on individual state policy. If the parent/student is eligible for a refund this will be processed through the Embry-Riddle Bursars Office and the parent/student notified.

Reason/ Justification *

HS Counselor Information

First Name: *

Last Name: *

Email: *

Electronic Signature *

Date
10/09/2025

Retyping your name here constitutes your electronic signature.