Fill - Free fillable Hardship Withdrawal Request Information Sheet (Central Georgia Technical College) PDF form

General Information:

Students may request a Hardship Withdrawal when a traumatic event prevents them from com-

pleting course work for the current semester. The possibility that a student will fail a course is not

considered a hardship.

Some examples of Hardship Withdrawals are:

• a medical emergency that requires prolonged rehabilitation or hospital stay.

• injury, illness or death of an immediate family member.

• re or other personal disaster.

• nancial devastation such as loss of a job by the student or head of their household.

• Being seated on a jury for more than ve days.

Hardship Withdrawals are indicated on the student’s grade record as a “W”.

Request for Hardship Withdrawals should be made before the last day of classes for the current

semester.

Hardship Withdrawals can be requested only after the withdrawal/drop period.

A student wanting to withdraw before the withdrawal deadline must follow the regular withdrawal

procedure.

As a general rule, students are not eligible for Hardship Withdrawals in courses in which they have

completed the course requirements (e.g., sat for the nal exam or submitted the nal project/paper/

portfolio).

There are individual situations which may cause students to believe they should receive a Hardship

Withdrawal. Often, these do not rise to the level of hardship. Two of the more frequently cited

circumstances are a lack of knowledge by the student about the mid-point of the semester dead-

line for dropping classes and transportation failures. Neither of these reasons constitutes the basis

for approval of a Hardship Withdrawal. Other circumstances may exist which also fail to reach the

hardship standard.

The Registrar’s Oce will receive and review requests submitted by students. Decisions are com-

municated to students via their CGTC email, and appropriate administrative oces are notied.

Note: If it is determined that a student is not capable of completing this process, the student’s par-

ent, guardian, or legal next of kin may act on behalf of the student. If the request is not approved,

the student will receive the grade earned in the class.

Eect on your Financial Aid:

Students must meet Satisfactory Academic Progress (SAP) in order to receive nancial aid for future

terms. Standards of Academic Progress are measured by having a completion rate of at least 67%

of all classes attempted, maintaining a 2.0 grade point average or better, and not going over the

maximum hours for their program. If a student is not meeting these standards, the student may

submit a SAP appeal with Financial Aid.

A Unit of the Technical College System of Georgia

Hardship Withdrawal Request

Information Sheet

Page 1

As set forth in its student catalog, Central Georgia Technical College (CGTC) does not discriminate on the basis of race, color, creed, naonal or ethnic origin, sex, religion,

disability, age, polical aliaon or belief, genec informaon, veteran status, or cizenship status (except in those special circumstances permied or mandated by law). The

following person has been designated to handle inquiries regarding the non-discriminaon policies: The Title VI/Title IX/Secon 504/ADA Coordinator for CGTC nondiscrimina-

on policies is Cathy Johnson, Execuve Director of Conduct, Appeals & Compliance; Room A-136, 80 Cohen Walker Drive, Warner Robins, GA 31088; Phone: (478) 218-3309;

Fax: (478) 471-5197; Email: cajohnson@centralgatech.edu.

Revised 10/09/2020

Page 2

Hardship Withdrawal Request Information Sheet

A Unit of the Technical College System of Georgia

If your Hardship Withdrawal is approved, you will be withdrawn from all registered courses with a

grade of “W” with the exception of classes that have already ended or classes for which the with-

drawal deadline has not passed. A Hardship Withdrawal may have an adverse eect on your

student loans, VA benets/tuition assistance, or other forms of nancial aid. You should contact

Financial Aid (naid@centralgatech.edu) to inquire how this withdrawal will aect your nancial aid.

Supporting Documentation:

To request a Hardship Withdrawal, please complete the 4 sections of the attached Hardship With-

drawal Request form with supporting documents. Please email supporting documentation to

registaroce@centralgatech.edu. Examples of supporting documents are listed below.

A. Hardship Withdrawals due to medical issues may include terminal illness, hospitalization,

etc. Supporting documentation may include hospital admittance and discharge papers with

dates. A dated letter from your Doctor about your medical care listing why your illness is

preventing you from completing college. A letter must contain the doctor’s contact informa-

tion with a valid phone number.

B. Hardship Withdrawals due to personal reasons may include death of an immediate family

member or family member who is critically ill, loss of home due to re, incarceration, etc.

Supporting documentation for Personal Reasons may include ocial death certicate in

addition to proof of relationship to the deceased. Proof that it is a hardship may include

notarized forms, statements, obituary, hospital forms, letter from landlord, homeowner,

mortgage company with contact information, indictment forms, etc.

C. Hardship Withdrawal due to military reasons may include a change in duty station or a call

to active military duty. Supporting documentation for military duty must include ocial

orders with dates. Enlisting in the military is not an acceptable withdrawal reason.

D. Supporting documentation for jury seating must be signed by a court ocial.

E. Hardships due to nancial reasons usually means job loss or other nancial setbacks to

the student or the student’s head of household. Supporting documentation for nancial

reasons may include letter from an employer explaining your job changes or relocation, or

unemployment forms proving job loss.

All supporting documentation will be veried; therefore, valid phone numbers must be in-

cluded.

Review Process:

A panel consisting of Associate Dean of Academic Aairs, Financial Aid, and the Registrar’s Oce will

review requests submitted by students. Final approval of the request will be made by the Registrar’s

Oce. All decisions are communicated to students via their CGTC email, and appropriate adminis-

trative oces are notied.

The review process may take up to two weeks. However, upon approval, all courses will be with-

drawn (with the exception of courses that have already ended) using the date of impact listed on the

Hardship Withdrawal Request Form.

If the request is not approved, the student will receive the grade earned in the class.

If you have any questions, please email registaroce@centralgatech.edu.

Please complete all four sections of the form. Incomplete requests will not be processed. You will be

notified by your CGTC student email of the decision. Submit the completed form and all documentation

to registraroffice@centralgatech.edu. A decision will be made 2 weeks from the date this form and

documentation is received.

Section I

First Name: __________________________________________ Last Name:_______________________________________________

Student ID Number: _____________________________________ Phone Number: ______________________________________

Street Address: ____________________________________________________________________ Apt/Lot/Suite:_______________

City: ____________________________________________ State: ______________________ Zip Code: _________________________

Student Email: ____________________________________@student.centralgatech.edu

Term/Year of withdraw Request (ex. Fall/2020): ___________________ Date of Impact/Hardhip: ___________________

Section II

Please select the type of Hardship Withdrawal you are requesting. To process your request, you must

provide supporting documentation. See the instruction page for a list of acceptable documents.

Note: when submitting supporting documentation, please provide correct phone numbers so all infor-

mation can be veried.

 Medical:

Hospitalization, critical illness, or other medical related reason.

 Personal:

Death in the family or family member who is critically ill, incarceration, loss of home due to re, etc.

 Military Duty:

Reassignment of duty station, call to active duty, etc.

 Extended Jury Selection:

Selected for Jury Duty which lasts for more than 5 days.

 Financial:

Loss of job, your head of household facing nancial issues, etc.

Section III

By signing this form, you understand that you will be withdrawn from ALL registered courses for this

term with the exception of courses that have already ended. You understand that it is your responsibili-

ty to contact the Financial Aid Oce to nd out about adjustments to your account. You also understand

that a Hardship Withdrawal may have an adverse eect on your student loans, VA benets/tuition assis-

tance, or other forms of nancial aid. Contact Financial Aid at 478-757-3422 or 478-988-6871 or

naid@centralgatech.edu.

Student Signature:__________________________________________________________________ Date: ______________________

For oce use only:

Date Submitted: _______________________________ Documentation Received: Yes No

A Unit of the Technical College System of Georgia

Hardship Withdrawal

Request Form

Page 1

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Section IV

As set forth in its student catalog, Central Georgia Technical College (CGTC) does not discriminate on the basis of race, color, creed, naonal or ethnic origin, sex, religion,

disability, age, polical aliaon or belief, genec informaon, veteran status, or cizenship status (except in those special circumstances permied or mandated by law). The

following person has been designated to handle inquiries regarding the non-discriminaon policies: The Title VI/Title IX/Secon 504/ADA Coordinator for CGTC nondiscrimina-

on policies is Cathy Johnson, Execuve Director of Conduct, Appeals & Compliance; Room A-136, 80 Cohen Walker Drive, Warner Robins, GA 31088; Phone: (478) 218-3309;

Fax: (478) 471-5197; Email: cajohnson@centralgatech.edu.

Revised 10/08/2020

Page 2

Please print. Attach additional sheet(s) if needed.

Please provide a detailed explanation for the Hardship Request:

_______________________________________________________________________________________________________________

Are you the student speaking on your behalf? (FERPA, LA #2, 99.4 & 99.5). Yes No*

*if no, please give your name and relationship to the student below:

Name: _______________________________________________________________ Relationship: _____________________________________

Hardship Withdraw Request Form

A Unit of the Technical College System of Georgia

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