First Name *

Last Name *

E-mail *
Please enter a GVSU email address ending in @gvsu.edu or @mail.gvsu.edu.

E-mail (Confirmation) *

Phone *

Course and section number *

Instructor Name *

Please explain why you would like to withdraw from the class. If applicable, include any changes in your circumstances that have occurred during the semester, along with the dates of those changes. *

Are you seeking to withdraw from any courses other than the physics class? *
Please enter at most 200 words. You currently have:

Please explain why you did not withdraw from the class before the regular deadline. *