CCPE Course Withdrawal Form

First Name *
Middle Initial
Last Name *
Please use the first and last name you used at registration.
Email *
Daytime Phone *
Evening Phone *
GU ID
Please provide your current address. This is where your refund will be mailed (if applicable).
Current Address Line 1 *
Current Address Line 2
City *
State *
Zipcode *
Please provide the address you used at registration if different from your current address. This will be used for identification purposes.
Address Line 1
Address Line 2
City
State
Zipcode
Please provide details on the course you wish to be withdrawn from. For more information on CCPE's withdrawal policy and schedule, please click here.
Course Name *
Course Number
Course Start Date *
Reason for Withdrawal

* indicates required field
Georgetown University
School of Continuing Studies
Box 571006
Washington, DC 20057
(202) 687-8700
Georgetown University
Center for Continuing and Professional Education
3101 Wilson Boulevard, Suite 200
Arlington, VA 22201
(202) 687-7000