COVID-19 Health Withdrawal Notice Form

Complete this form to initiate a COVID-19 Health Withdrawal from your course(s). This process is managed by the Dean of Students.

Name

CNM ID Number

Telephone Number

I am requesting the COVID-19 Health Withdrawal to care for myself, a family member or other. Please select all that apply.

Myself Family member Other

If you selected "other" please explain.

I am requesting to be withdrawn from the classes listed below.

I understand that there may be impacts for my financial aid by dropping my classes.

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