Class Relinquishment Claim Form
Submit your request to relinquish a class. Please complete all required fields to process your claim.
Student Full Name
*
First Name
Last Name
Student Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Class/Course to Relinquish
*
Reason for Relinquishment
*
Date of Relinquishment Request
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Supporting Documents (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Claim
Should be Empty: