Drop Form for 100% Online Courses

Please consult with your Advisor before dropping a course since it may affect your Financial Aid, Veteran’s Benefits and/or student status.

In order to qualify for a 100% refund:

a) Complete this form and deliver it to the Registrar’s Office at the college offering the course by date for 100% refunds for the current term as defined by the college offering the 100% online course.

b) To ensure the Registrar has this document by the final day for 100% refunds, deliver this completed form to the Registrar in person.

c) If you have to mail it, send it by U.S. mail and get a signature guarantee so you can verify the date it was delivered to the Registrar.

d) Email a copy of this completed form to your Instructor so he/she will know immediately that you are no longer in the course.

Please complete the questions below and deliver as follows:

1. A signed copy to the Registrar of the college offering the course

2. A copy to your Instructor - copy and paste into an email or send paper copy by U.S. mail

3. A copy to your Advisor - copy and paste into an email or send paper copy by U.S. mail

Date:

Semester and year (fall, spring or summer):

Reason for dropping course:

Your name (Last name, first name, middle initial):

Your student ID# (Usually your social security number):

Your Home College (college where you are enrolled in a program):

(Berlin, Claremont, Concord (NHTI), Laconia, Manchester, Nashua, Pease or Stratham)

Host (College Offering the Course):

Course Catalog # (example: BUS245 ZZ)*:

Course Name: (example: Organizational Behavior)*:

Number of course credits:(Usually 3 or 4 credits)*:

Course CRN # (example: 21399)*:

Your Instructor’s Name*:

Your Advisor’s Name:

Date you delivered, U.S. mailed or emailed a copy of this completed form to your Instructor (example: Jan. 23, 2003):

Which method? (Hand delivered, U.S. mail or Email):

Date you delivered, U.S. mailed or emailed a copy of this completed form to your Advisor (example: Jan. 23, 2003)

Which method? (Hand delivered, U.S. mail or Email):

I understand that by registering at this Community Technical College I am financially obligated for ALL costs related to the registered courses.

Upon a course drop or withdrawal, I understand I will be responsible for all charges as noted in the student catalog and handbook.

If I do not make payment in full, I understand my account may be reported to the credit bureau and/or turned over to an outside collection agency.

I also understand I will be responsible for the costs of the outside collection agency and/or any legal fees (which may add a significant cost to my existing account balance).

Your signature:

Date of your signature:

Your completed drop form attached to emails sent to your Instructor and Advisor will not have a signature. However, the Registrar must have the original signed copy.

* Instructor names and email addresses, course catalog numbers, course names, credits and CRN numbers are available in the Online Learning area of http://www.nhctc.edu

For Registrar’s office use only:

Date drop form received:

Name of person who received drop form:

Refund (date and % to be refunded):

Copy to Registrar:

Copy to Student:

Copy to Financial Aid:

Copy to Advisor:

Copy to Instructor: