Withdrawal - Complete - Jefferson State Community College 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your full name, student number, or SSN in the designated fields. Ensure accuracy for proper identification.
3. Fill in your current address, including street, city, county, state, and zip code. If this is an address change, indicate 'Yes' or 'No' as applicable.
4. Review the refund information section carefully. Understand that refunds are based on the first official class day and ensure all financial obligations are cleared before submission.
5. Answer the questions regarding financial aid and your primary reason for withdrawing by circling the appropriate responses. Choose only one reason from the provided list.
6. Indicate whether you plan to return to Jefferson State at a later date by selecting Yes, No, or Don’t know at this time.
7. Use the space provided to share any feedback on how faculty or staff could have supported your retention this term.
8. Finally, sign and date the form before submitting it via fax or mail as instructed.

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