COACHES REPORT OF WITHDRAWAL
Department of Athletics
(714) 278-3058 / Fax (714) 278-5396

	
	Student Name

	Social Security #

	Sport

The above student has withdrawn from	 for one of the following
	Sport
 reasons:	  Quit Team
	  Cut From Team
	  Transferred
	  Eligibility Expired
	 Academically Ineligible

  Yes    No  The above student is receiving an athletics grant-in-aid and is aware that this 

grant-in-aid  will be cancelled as of	 and has also been informed of his/her
		Date
right to appeal.

		
Head Coach	Date

		
Director of Athletics	Date

NOTE:  Institutional financial aid based in any degree on athletics ability may be reduced or canceled during the period of the award if the recipient voluntarily withdraws from a sport at any time for personal reasons.  (NCAA By-laws 15.3.4.1d)