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LATE WITHDRAWAL REQUEST (Rockland Community College)

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ROCKLAND COMMUNITY COLLEGE
LATE WITHDRAWAL REQUEST
Records & Registration
Instructions
A late withdrawal request may be submitted after the published Last Day to Withdraw if it is approved by
your instructor. In the last three weeks of the fall or spring semester a late withdrawal request must also
be approved by the Provost/Executive Vice President who is RCC’s Chief Academic Officer. When the late
withdrawal occurs in weeks 13 through the end of the semester, additional supporting documentation
must also be provided. See the time frames below for all academic terms, including Wintersession and
Summer sessions.
Late Withdrawal Signature Requirements
Academic Term
Instructor Signature Only
Provost’s Signature and Supporting
Documentation Required
Wintersession
From the published Last Day to Withdraw
up to the last 5 days of the session
Last 5 calendar days of the session
Spring Semester
From the published Last Day to Withdraw
through week 12 of the semester
Weeks 13 through the end of the semester
Summer Session 1
From the published Last Day to Withdraw
up to the last 10 days of the session
Last 10 calendar days of the session
Summer Session 2
From the published Last Day to Withdraw
up to the last 15 days of the session
Last 15 calendar days of the session
Summer Session 3
From the published Last Day to Withdraw
up to the last 10 days of the session
Last 10 calendar days of the session
Fall Semester
From the published Last Day to Withdraw
through week 12 of the semester
Weeks 13 through the end of the semester
You should complete the Late Withdrawal Request form and first seek the approval and signature of your
course instructor. In all cases, the course instructor must approve the late withdrawal. In weeks 10, 11,
and 12 of the fall/spring semesters, the instructor’s signature alone is sufficient a nd no additional
documentation is required. Submit the instructor-signed form to Records & Registration either in-person
or via email at records@sunyrockland.edu. If you are emailing, you must include a photo of your picture ID.
Requests Needing the Provost’s Approval
In week’s 13 through the end of the Fall and Spring semesters and during the last days of the shorter
Wintersession and Summer sessions, the Provost’s approval to withdraw is required in addition to your
instructor’s approval. During these time frames, additional supporting documentation is also required. The
Provost will not consider requests that are not filed in compliance with these procedures or are
incomplete. Late Withdrawals are only for the most serious situations. Requests for reasons other than
those outlined on page 3, such as grade dissatisfaction, will not be honored.
The decision of the Provost is final an d will be forwarded to the student and to Records & Registration for
processing. Submit the completed Supporting Documentation section on page 3 of this form, the
instructor-signed Late Withdrawal Request Form, and a photo of your picture ID to
academicaffairs@sunyrockland.edu.
ROCKLAND COMMUNITY COLLEGE
LATE WITHDRAWAL REQUEST
Records & Registration
Student's Last Name ___________________________ First Name __________________________ MI ___
SS# or College ID# _________________________________________ DOB __________________________
Email address ___________________________@sunyrockland.edu Semester___________________
CRN
Course Code: Dept-
Code-Section
Course Title Credits Days Time
Example: 50270
ENG-10100-521 College Writing I 3 Online
NOTE: If you are requesting a withdrawal from more than one course, a Late Withdrawal Request form
must be filled out for each course.
I have read the instructions and understand that the approval of a late withdrawal for the course noted
above will result in a “W” grade on my academic record and that no tuition refund will be issued.
Student's Signature __________________________________________ Date ________________________
All Requests Need Instructor Approval
Faculty / Instructor Signature _________________________________________ Date _________________
For Requests Needing Provost’s Approval - - Supporting Documentation is Also Required
Provost Signature ____________________________________________ Date ___________________
Approve Request ____________________ Disapprove Request _____________________
Comments ______________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
************************Confidential Information******************************
Supporting Documentation
This section must be completed if you are submitting the Late Withdrawal Request in the time frame
needing the Provost’s approval (see time frames outlined on page 1).
Student's Last Name ___________________________ First Name __________________________ MI ___
SS# or College ID# _________________________________________ DOB __________________________
Course Code and Course Title ________________________________________________________________
Last Date Attended in the Course __________________ Grade Earned to Date _____________________
Reason for drop: _____ Death in Family ____Major Accident/Incident
_____Acute Illness ____Severe Personal Hardship
Please explain your request for the late withdrawal. Clear documentation must be provided to support
your request. Requests for reasons other than those outlined above, such as grade dissatisfaction, will not
be honored. Attach additional explanation or documentation as appropriate. Additional documentation
may be requested, if needed.
Student's Signature ________________________________________ Date __________________________
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Completed 15 June 2021

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