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? Yes No

*Are you a member of SEO (Student Educational Opportunity)?  Yes No

*Are you a student athlete? Yes No

*Are you a veteran? Yes No

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. Yes

*By withdrawing from this course my future academic status may be affected. Yes .

*By withdrawing from this course my financial aid could be affected. Yes

*I should contact my advisor and Financial Aid regarding the implications of this withdrawal. Yes

*I understand if I withdraw from this course, I will receive a grade of a “W” on my transcript. Yes  

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.