Santa Ana College
Admissions & Records Office
1530 W. 17th Street, Santa Ana, CA 92706
www.sac.edu phone: (714) 564-6007
email: Adm_Records@sac.edu

COVID-19
Request for Spring 2020 Excused Withdrawal

IMPORTANT: This form is to request an Excused Withdrawal (EW) and refund of enrollment fees due to the COVID-19 crisis.
An EW will not affect your academic probation status or towards the permitted number of withdrawals/attempts. The EW
may affect other benefits such as Financial Aid, Veterans, Sponsorship, Athletics, etc. It is recommended that you contact
these programs to understand the ramifications of this request.

Student Name: _____________________________________________________
(Last)

Phone: _________________________________

(First)

Student ID#: _______________________

E-Mail: ______________________________________________________

By signing below, I am indicating that I understand the ramifications of this request for an EW grade.

Student Signature: ______________________________________________________

Date: ________________________

Please list all of the classes in which you are requesting to be withdrawn from due to the COVID-19 crisis.
Course Subject/Number
(e.g. ENGL-101)

Section Number
(e.g. 54321)

Campus
Location

This request must be emailed to Adm_Records@sac.edu. Please allow up to 14 days for refund processing.

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