Exception to Course Withdrawal Deadline

Request for Exception to Course Withdrawal Deadline
{studentFull} should have already completed Section A. Please complete Section B about {studentFull}'s attendance and grades in your course, and submit the form.
SECTION A. To be completed by student
NOTE: The Committee on Academic Standing only reviews petitions during the fall and spring semesters.
Please complete a separate form for each individual course. You will be notified of the decision of the Committee on Academic Standing via e-mail. If approved, a processing fee will be collected by the Registrar’s Office ($20 per transaction). You will have five (5) business days from the approval date to take action. If you do not, you will have to petition again.

Making false statements and/or filing forged documents and/or submitting false material to a University committee violates the standards of academic integrity. Such violations will be subject to appropriate disciplinary action.
Student Full Name *

First Name Middle Initial Last Name
Student ID number *
e.g., 001234567
Student Email *
example@albany.edu
Student Phone Number *

Area Code Phone Number
Instructor *

Prefix First Name Last Name
Instructor Email *
example@albany.edu
Course Subject *
e.g., AHIS
Course Catalog # *
e.g., 100
Class # *
e.g., 2497
Number of credits *
e.g., 3
Term *
e.g., Fall
Year *
e.g., 2019
Please provide a brief written statement indicating why you were not able to drop the course before the published deadline. *

0/250
Documentation to support your petition must be submitted for review.

Being unaware of the policy or deadline, changing your mind because of poor test results or unfulfilled class expectations, after the deadline, will not qualify as a policy exception.

This is a request for an exception. There should be no expectation that your petition will be approved. You are expected to continue attending classes.

The Committee on Academic Standing only reviews petitions during the fall and spring semesters.
Do you have documentation to support your request? *

Yes No
Upload any documentation to support your petition: *

Browse Files

Cancel of
If your extenuating circumstances are not documents and/or you do not have documentation, please state below.
Please check each of the options below, indicating that you understand each checkbox. *

I understand that my request WILL NOT be reviewed unless the form is completed in its entirety. I understand I should continue to participate in coursework pending the results of this petition. I understand it is my responsibility to find out the status of my request by emailing the committee or inquiring at the Undergraduate Education Office. I understand that enrollment changes may impact my eligibility for financial aid for current and/or future terms. I have contacted the Office of Financial Aid (Campus Center G-25 or 518-442-3202) to inquire how a late withdrawal will affect my aid. I understand that if approved, I will have five (5) business days from the approval date to take action. If not, I will have to petition again. I understand that if I receive a “W” for this course(s), my standing for graduation may change. I understand that no other individuals may request information pertaining to this petition or the materials submitted in support (e.g., parents, guardians, etc.). All matters will be kept confidential between the Committee on Academic Standing, the Office of the Vice Provost for Undergraduate Education, and necessary University representatives with a legitimate educational interest that the Committee deems appropriate.
NOTE: If you received your bachelor's degree from UA you do NOT qualify for this exception.

As of Fall 2018, you CANNOT initiate late withdrawal requests that date back more than one year.
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.

When you press the submit button, your instructor will also receive an email, with a link to another form that he or she needs to complete. You must check with your instructor to confirm that they have completed Section B.
Student's Signature *
Today's Date *

Month Day Year
SECTION B. To be completed by instructor

NOTE: This section is ONLY to be completed by the instructor. If you are a student, please make sure to mark "Click here if you are a student" at the top of the page, and your instructor will receive directions for completing this section.
Instructor Name

Prefix First Name Last Name
Student...

is still attending stopped attending attended the entire semester
Date student stopped attending:
Student...

HAS received grades and/or other evaluations HAS NOT received any grades or other evaluations
Please indicate the dates of assignments completed, and include the letter grade or numeric grade the student received
Comments:
By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application.

When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your submission.
Instructor's Signature
Today's Date

Month Day Year
Should be Empty:

Request for Exception to Course Withdrawal Deadline

SECTION A. To be completed by student

SECTION B. To be completed by instructor