Office Use ONLY
Faculty-Initiated Withdrawal Form
Faculty may recommend that Edison State withdraw a student within the withdrawal period and issue that student a
grade of “UW”, (Unofficial Withdrawal). A student should be removed from a class once it becomes mathematically
impossible for the student to pass the course due to non-participation. Non-participation is defined as missing three
consecutive weeks of class or coursework, with no response to attempts to contact or to the academic alert. Students
who are participating (even if failing) should not be removed from the course.
ALL criteria below must be met to recommend an Unofficial Withdrawal (UW).
1. The student is not mathematically able to pass the course
2. The student has not attended class for three consecutive weeks of a 16-week section or equivalent
a. For online courses no submission of assigned coursework for three weeks
3. Faculty has attempted to contact student and has issued an academic alert
4. Student has not responded to communication attempts/academic alerts
Every effort should be made to encourage the student to self-withdraw. If repeated attempts at communication are
ignored by the student, the faculty may recommend the student for Unofficial Withdrawal (UW). This form must be
submitted before the withdrawal deadline.
Student Name: Student ID:
Course Number
Last Date of Attendance
Example: BIO 126S 001SS
Spring 2018
What attempts have you made to communicate with
the student about the concern? (select all that apply
and provide dates)
Spoke to student in class on
Emailed student on
Submitted an Academic Alert on
Reasons for withdrawing the student
The student has (select all that apply)
Stopped participating
Not responded to communication
No possibility of passing the class
By signing this form, I confirm that the above named student has not responded to my attempts of communication.
There is no mathematical possibility of passing the class and I am requesting an Unofficial Withdrawal be processed and
a final grade of ‘UW’ be given for this course.
Faculty Signature Date
Submit to or Room 160 - MUST be received before the withdrawal deadline
click to sign
click to edit