A customized academic form for requesting course withdrawal, aimed at organizing and documenting the student's request to withdraw from one or more courses in accordance with approved academic procedures. The form includes the student's academic data, in addition to the details of the course or courses requested for withdrawal, which helps specify the request and link it to the student's academic status. The form also allows for explaining the reasons for submitting the withdrawal request, providing information that helps in reviewing the request and understanding its motives. Furthermore, it includes a statement indicating whether the student has previously withdrawn from the course, which helps document related past cases. The form enables the academic advisor to express their opinion and record observations regarding the request, ensuring an advisory aspect when dealing with the academic decision. It also includes an acknowledgment by the student of their awareness of the academic consequences resulting from the withdrawal and bearing responsibility for the decision, which is an important element to document the student's awareness of the implications of their request. The form serves as an organized tool that gathers the student's data, the course, the reason for the request, the advisor's opinion, and the student's acknowledgment into a single document, helping to clarify procedures, facilitate the review of the request, and make the appropriate decision regarding it in accordance with applicable regulations.