Request
to Withdraw
NOTE: 1. Class withdraw requests are for the current term only.
2.
If approved, a grade of "W" will be assigned.
* Indicates a required entry
*Your First Name Your
Middle Name *Your Last Name
*Student SID or W Number *Your EMail
Address
Academic Advisor EMail Address
Instructor EMail Address
I wish to withdraw from the following Course:
*Course Prefix *Course
Number *Course Section
Number
*Course Title *Credit
Hours
*Instructor Name
Reason for Withdraw
*Are you receiving
Financial Aid?
*Are you a member
of SEO (Student Educational Opportunity)?
*Are you a student
athlete?
*Are you a
veteran?
When requesting to withdraw from this course, I have
considered the following:
*If
this course is a prerequisite for other courses, withdrawing from this
course could delay my graduation.
*By
withdrawing from this course my future academic status may be affected..
*By
withdrawing from this course my financial aid could be affected.
*I
should contact my advisor and Financial Aid regarding the implications of
this withdrawal.
*I
understand if I withdraw from this course, I will receive a grade of a
“W” on my transcript.
You are responsible for tracking the progress of your petition using the confirmation number received once you have submitted your petition. Therefore, you may find it useful to print out the completed form for the tracking number and for your own personal records. The electronic petition process can involve contacting a number of faculty/staff members. For this reason please allow up to two weeks processing time for your petition.
I certify that the information I have provided is correct to
the best of my knowledge. If my request is accepted, I agree to abide by the
policies, rules and regulations of the University of Wyoming. I further understand that
the information submitted herein will be relied upon by the Officials of the University in determining my request and that the submission of false
information is a violation of Federal and State Law. WITHOUT CORRECT
CERTIFICATION THIS REQUEST WILL NOT BE PROCESSED.
* Select Yes for Certification
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