FORM 12 GRADUATE STUDENT COURSE WITHDRAWAL REQUEST
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Graduate School—Central Connecticut State University, 1615 Stanley Street, New Britain CT 06050
Program: Doctorate Sixth Year Master's Teacher Certification OCP
Number of credits you will carry if withdrawal is approved:
To the Student: Dropping courses without notation on the academic record is allowed up to the last day of the third week of classes during a regu-
lar semester. During this period, a full-time graduate student who drops below the nine (9) credit minimum must change to part-time status.
From the beginning of the fourth week of classes until the end of the eighth week of classes (or mid-term), full-time or part-time graduate students can with-
draw from any course using this Withdrawal Request Form. A “W” will be entered for the course(s) on a student’s transcript. During this period, approvals
for course withdrawal are not required, but it is strongly recommended that students consult with their academic advisor prior to making a decision. Full-
time graduate students should be aware that failure to carry a minimum of nine (9) semester hours may affect Satisfactory Aca demic Progress (SAP) and
receipt of certain federal, state, and other benefits including but not limited to various financial aid programs, Veterans' benefits, and Social Security bene-
fits. Students dropping below nine (9) semester hours are ineligible for participation in intercollegiate athletics.
After the eighth week of classes ends, students may also apply for course withdrawal using this form. At that point, signatures indicating the recommen-
dation of the instructor, the approval of the department chair and dean of the academic school offering the course, as well a s the graduate dean are required.
To request withdrawal, complete this form and bring it to your instructor. Next, obtain the signatures of the Department Cha ir, the Chair's Academic Dean,
if applicable, and the Dean of Graduate Studies. Withdrawal from a course may be approved if extenuating circumstances are found to exist and a "W" will
be recorded on the student’s transcript. Poor academic performance is not an extenuating circumstance. Non -attendance and failure to withdraw officially
may result in a grade of "F." This form is a request to withdraw from a course and may not be approved. You should continue attending class until
your request is confirmed by the Dean of Graduate Studies.
In all cases of withdrawal, a “W” does not affect the student’s grade point average. Course withdrawal requests are processed by the Registrar until one
week prior to the conclusion of an academic semester.
I request permission to withdraw without academic penalty from:
5-Digit Code Number Course No. (i.e., ED 511) Section No. (i.e., 70) Short Title (i.e., Evaluation) Credits (3,6) Instructor’s Name
Reason for Withdrawal Date
Instructor: Grade at time of withdrawal:
Remarks:
"W" is : [ ] recommended [ ] not recommended Signature Date
Department Chair:
Remarks:
"W" is : [ ] approved [ ] not approved Signature _ Date
Dean, School of Education and Professional Studies:*
Remarks:
"W" is: [ ] approved [ ] not approved Signature Date
*Required if you are enrolled in a graduate certification OR degree program leading to a teacher or school professional endorsement
VP, Academic Affairs, Dean, School of Graduate Studies: ________________________________________________ ___ Date__________________
Remarks:
"W" is: [ ] approved [ ] not approved Signature Date
Date of Registrar's Receipt
Student Notified: [ ]
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