Application for Drop/Withdrawal Appeal Spring 2020
Students who find it necessary to drop or withdraw for spring 2020 semester due to medical, family emergency, or
other extenuating circumstances may request drop/withdrawal appeal. Appeals must include appropriately dated
documentation that corresponds to the spring 2020 semester as evidence of a circumstance beyond the student’s
control, preventing the student from withdrawing on or before the published deadlines due to extenuating
circumstances (medical, military, family emergency or natural disasters)
Documentation required:
Medical Appeal: A letter from your medical provider with details noted on attachments, if applicable.
Other Appeal: A brief statement by you regarding your current circumstances explaining why you are seeking
drop/withdrawal.
Examples of why an appeal may not be considered:
If the appeal is not received by the end of the following semester. (Last day of Fall 2020 for Spring 2020
appeal)
Failure to follow proper drop/withdrawal procedures.
Lack of knowledge of applicable dates and deadlines.
Changes in job, work schedule or employment (unless related to a natural disaster with sufficient
documentation).
Failure to verify class schedule and/or schedule changes.
Non-attendance of class(es).
Personal errors in judgment regarding:
o Availability of finances to pay associated charges
o Class work load and academic ability
o Time management
o Availability of transportation to and from class
Dissatisfaction with course content or method of instruction. If appealing is for this reason, please contact
the Associate Provost/Dean of Instruction at 483-2149
Inadequate, late application or loss of eligibility of financial aid, scholarships, or third party authorization.
Non-receipt of information/notices sent to student's email and/or USPS address.
Not benefiting from:
o A fee (e.g. wishing to appeal the mandatory/student/class/course/program fees)
o Course credits in regard to degree requirements or changes in major
Lack of proper, descriptive documentation.
Name ________ Student ID # _________________
Address
City State _____________ Zip ____________________________
Phone #_________________________ Email: ________________________________________
Semester(s) of requested drop/withdrawal: Year Fall Spring Summer
List each course and last day of attendance for which you are requesting drop/withdrawal:
Course 1:
Subject_______ Catalog Number_____ Class Title____________________ Last day of Attendance______
Course 2:
Subject_______ Catalog Number_____ Class Title____________________ Last day of Attendance______
Course 3:
Subject_______ Catalog Number_____ Class Title____________________ Last day of Attendance______
Course 4:
Subject_______ Catalog Number_____ Class Title____________________ Last day of Attendance______
Course 5:
Subject_______ Catalog Number_____ Class Title____________________ Last day of Attendance______
Course 6:
Subject_______ Catalog Number_____ Class Title____________________ Last day of Attendance______
Course 7:
Subject_______ Catalog Number_____ Class Title____________________ Last day of Attendance______
I hereby request a drop/withdrawal appeal from enrollment at Dickinson State University due extenuating circumstances. I
authorize DSU representatives to review my medical records and/or other related documentation as necessary to determine my
eligibility for a drop/withdrawal and/or a refund of fees.
Signature Date
Complete all information below and submit this form and required documentation to:
Dickinson State University, Student Affairs, 291 Campus Drive, Dickinson, ND 58601
Fax: (701) 483-9959
Phone: (701) 483-2089
_______________________________ _______________ _______Approved _________Not Approved
Director of Academic Records Date
_______________________________ _______________ _______Approved _________Not Approved
Vice President of Academic Affairs Date
_______________________________ _______________ _______Approved _________Not Approved
Vice President of Student Affairs Date
(if applicable)
_______________________________ _______________ _______Approved _________Not Approved
Business Affairs Date
______________________________ _______________ _______Approved _________Not Approved
Financial Aid Date
___________Withdrawal % __________Withdrawal with Penalty (W) _________Withdrawal without penalty (no W)
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