Course Withdrawal Request- Spring 2022
This form is used by students to request the withdrawal from a course at Massachusetts Maritime Academy.

Please use the Maritime emails for both your Instructor and your faculty adviser.  Check Self Service to find your adviser's name and email address.


I request to withdraw from the course listed below. I understand that I am allowed to withdraw from only one course a semester. I may not withdraw from any class previously failed or withdrawn from. I may not withdraw from Pre-Calculus with Trigonometry or Problem Solving with Mathematics. I may not withdraw from Calculus II if I am registered in Engineering Physics I.  I have been counseled by my instructor and by my academic advisor and feel that withdrawal is in my best interest at this time. I have been advised to consult the Office of Student Financial Services to understand the impact on my financial aid eligibility. I understand that this may impact my subsequent scheduling and graduation date.

Students can not withdraw from the following classes:
Problem Solving with Mathematics
Pre-Calculus with Trigonometry
Calculus II if registered in Engineering Physics I.

Sign in to Google to save your progress. Learn more
Full Name *
Student ID Number *
Students Major *
Course Name and Section Requesting Withdrawal   Please show as (XX-####-##) Class Name *
Course Instructor Name *
Course Instructor Email *
Advisor Name
Advisor Email *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Massachusetts Maritime Academy.

Does this form look suspicious? Report