Academic Drop/Withdrawl Appeal

* First Name:
 
Middle Name:
* Last Name:
 
* Date of Birth (00/00/0000):
  
* Student ID:
 
* Street Address:
 
* City:
 
* State:
 
* Zip:
 
* Phone (555-555-5555):
 
* Email:
 
* Do you receive GI Bill benefits:

 
* Drop/Withdrawal Term:
 
View your class schedule in CampusConnection to ensure the following information is complete. Appeals will not be processed if courses are not listed below.

Action Requesting Definitions
Appeal Action Requested Description
Grade to W Removal of current letter grade and change to Withdrawal with (W) record on transcript
Grade to No W Removal of current letter grade and change to Withdrawal without record on transcript
W to No W Removal of current Withdrawal with (W) record on transcript and change to Withdrawal without record on transcript

Course Appeal #1
* 1) Subject (ex ENGL):
 
* 1) Catalog # (ex 110):
 
* 1) Class # (ex. 10258):
 
* 1) Class Title (ex. College Composition I):
 
* 1) Action Requesting:
 
* 1) Last Date of Attendance:
  

Course Appeal #2
2) Subject:
2) Catalog #:
2) Class #:
2) Class Title:
2) Action Requesting:
2) Last Date of Attendance:
 

Course Appeal #3
3) Subject:
3) Catalog #:
3) Class #:
3) Class Title:
3) Action Requesting:
3) Last Date of Attendance:
 

Course Appeal #4
4) Subject:
4) Catalog #:
4) Class #:
4) Class Title:
4) Action Requesting:
4) Last Date of Attendance:
 

Course Appeal #5
5) Subject:
5) Catalog #:
5) Class #:
5) Class Title:
5) Action Requesting:
5) Last Date of Attendance:
 

Course Appeal #6
6) Subject:
6) Catalog #:
6) Class #:
6) Class Title:
6) Action Requesting:
6) Last Date of Attendance:
 

Course Appeal #7
7) Subject:
7) Catalog #:
7) Class #:
7) Class Title:
7) Action Requesting:
7) Last Date of Attendance:
 

Course Appeal #8
8) Subject:
8) Catalog #:
8) Class #:
8) Class Title:
8) Action Requesting:
8) Last Date of Attendance:
 

Course Appeal #9
9) Subject:
9) Catalog #:
9) Class #:
9) Class Title:
9) Action Requesting:
9) Last Date of Attendance:
 

Course Appeal #10
10) Subject:
10) Catalog #:
10) Class #:
10) Class Title:
10) Action Requesting:
10) Last Date of Attendance:
 
* Appeal Reason/Suggested Documentation:





 
* Explanation for Academic Records Appeal:
 
* I undertand that a denied appeal drop/withdraw application for the current term will be processed as a regular withdraw. All dates and deadlines for a regular withdraw will be followed. 
 
* I accept all academic and financial consequences resulting from this appeal. 
 
* Signature: I certify to the best of my knowledge that the information on this form is true and complete without evasion or misrepresentation. I understand that if found to be otherwise, it is sufficient cause for rejections or dismissal:
 
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