Appendix 3

SIR WINSTON CHURCHILL
CO-OPERATIVE EDUCATION DEPARTMENT

STUDENT WITHDRAWAL FORM


Student:
Course Code:

School:  
Monitor Teacher:

Placement: 
Supervisor’s Name:

Date: _________________________________

Reason for Withdrawal:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Comments:

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


Student Signature: ______________________________________________________

Supervisor Signature: ____________________________________________________

Parent/Guardian Signature: ________________________________________________

Co-op Monitor Signature: _________________________________________________

Cooperative Education Student Handbook |