Involuntary Withdrawal Process
and Documentation
An involuntary withdrawal may be requested whenever there are circumstances beyond the
student’s control which make it impossible to complete the course(s) in progress during a given
semester.
All involuntary withdrawals must include a completed Involuntary Withdrawal Form,
supporting documentation based on the reason for filing an involuntary withdrawal as
specified below, and a personal statement. This statement should include information on the
applicable semester, course(s), reason for withdrawal, and preferred outcome. Only complete
packets will be accepted by the Office of Enrollment Services.
A withdrawal is considered involuntary if it results from one of the following situations:
a. Called to active military duty via enlistment, activation, or deployment.
The request for withdrawal must be substantiated with copies of military orders signed by the
individual's commanding officer or another appropriate official to show proof of date effective.
You must also receive approval from a Military Enrollment Services Specialist at Montgomery
College.
b. Illness of the student or in the immediate family of the student. Immediate family includes a
child, parent, spouse, or other regular member of the individual's household.
Certification must be provided by the student's or family member's attending physician stating
that the student's or family member's illness requires the student's withdrawal.
Physician’s note must be on professional stationary, specify dates of treatment, and clearly
indicate that illness made it impossible for student to continue enrollment in classes.
c. Death of the student or in the immediate family of the student.
Appropriate substantiation must accompany the request for withdrawal. Examples include a
death certificate, notice, newspaper article, or funeral program.
Relationship to student must be clearly indicated in documentation.
d. Involuntary transfer/change in work hours by the student's employer which precludes
continued attendance. Military branches of service are considered employers under this
section.
A letter from the supervisor should be provided and appear on company letterhead, indicate
effective date of change in work schedule, and outline new work schedule.
Additional information regarding tuition, fees, and refund policies may be found at
http://www.montgomerycollege.edu/verified/pnp/45001.doc.
_____________________________________________________________
04/20/18
If your involuntary withdrawal is approved, you may receive a pro-rated refund of tuition based on
your date of withdrawal, last date of attendance, and/or effective date of your situation as
documented above. Fees are non-refundable.
If you are eligible for a full or pro-rated refund, this process may take a minimum of six
weeks to complete.
Involuntary Withdrawal
Form
Fill in all sections of this form. Only complete packets will be accepted.
This appeal is for courses taken at (check applicable campuses). If more than one campus, submit the appeal to the campus
where the majority of classes were taken.
Germantown Rockville Takoma Park/Silver Spring
During (check one semester and fill in the calendar year).
Fall semester Winter term Spring semester
Summer I session Summer II session
Name
First Middle Last
Student ID M-
Preferred phone number from 9am-5pm, Monday-Friday
Address
City State ZIP Code
MC Email Address @
I have reviewed this appeal and explained to the student the effect a financial adjustment will have on the student's
estimated, pending, awarded, or paid financial aid.
Comments:
DatePrinted NameFinancial Aid Officer Signature
Office Use Only (Initial/Date)
Did you apply for or receive Financial Aid (scholarships, loans and/or grants)?
Yes No
If Yes, obtain signature below or attach MC email from the Office of Financial Aid:
04/20/18
I have reviewed this appeal and explained to the student the effect a financial adjustment will have on the student's
visa status.
Comments:
Are you an F-1/M-1 visa holder?
Yes No
If Yes, obtain signature below or attach MC email from your International Student Coordinator:
International Student Coordinator Signature
Printed Name
Date
Involuntary withdrawal for (check one):
Call to active duty
Illness
Family death
Transfer/change in work
For the following classes (indicate course number and CRN, example: ENGL101, 22222).
Course Number, CRN
Course Number, CRN
Course Number, CRN
Course Number, CRN
Course Number, CRN
Course Number, CRN
Student Signature
Printed Name
Date
Are you using VA benefits?
Yes
No
If Yes, obtain signature below or attach MC email from your VA Certifying Official:
I have reviewed this appeal and explained to the student the effect a financial adjustment will have on the student's VA
benefits.
Comments:
VA Certifying Official
Printed Name
Date