Request to Drop Undergraduate Certification Major

Department of Education, Languages, and Instructional Design
SUNY Brockport

Today's Date Today's Date / MM / DD YYYY
Student Name Student Name First Last
Student Brockport Email

Brockport email if you have one
Banner ID Number
Must be 9 digits. Currently Entered: 3 digits.
Major you are withdrawing from:
IMPORTANT: This form notifies the Department of Education, Languages, and Instructional Design and the Field Experience Office that you are withdrawing from your ELID major.

You MUST go to the Academic Success Center to change your major OR you can complete the Major Minor Declaration form online.
Please type your full legal name here as a legal representation of your signature: