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Continuing Education Course Withdraw Request

Withdraw request form

Personal Information
Full Name:
Today's Date:
Course you wish to withdraw from
Course Title:
Course Code:
Reason for Withdraw? (Optional):

Thank you for your course withdraw request. Your withdraw from this course will be processed fully within 48 hours of receipt. You will receive an e-mail from us when your course withdraw is completed. If you paid for this course by credit card, we will process a "credit" for the cost of the course back to your account. You will receive an e-mail receipt of this credit. Please note that it may take your credit card company 4-5 days to post the credit back to your account. If you had paid by check or money, we will postal mail you a check for the amount. If you have any questions, please contact us at: info@aihcp.org