Exceptional Circumstances Withdrawal Request Form

If a student encounters an unforeseen circumstance that prevents them from completing their enrolled course(s), this form is used to request a withdrawal after the official withdrawal “W” deadline.

First and last name
Student Information
Course Information
e.g. ENGL 101-H01
Instructor Information
Reason for Withdrawal(Required)
Acknowledgement(Required)

Allow up to 5-10 business days for processing after all information has been reviewed.