Nicholls State University
Administrative Unit: ☐ College of Business Administration ☐ College of Education & Behavioral Sciences ☐ College of Liberal Arts
☐ College of Nursing ☐ College of Sciences & Technology ☐ Chef John Folse Culinary Institute ☐ Academic Services Center
Classification: ☐ Fres
hman ☐ Sophomore ☐ Junior ☐ Senior ☐ Graduate Major___________________________________
Na
me ____________________________________________________________ ID Number __________________________
Address ___________________________________ City __________________________ State ________ Zip Code ______________
Phone number where you can be reached between 8:00 a.m. and 4:30 p.m. (________) ___________-____________________
Prior to completing this form, it is recommended that students consult with the Office of Financial Aid to discuss the impact of this action
with regard to current and future financial aid awards and eligibility. Students should keep in mind that this is only a request and that
approval is not guaranteed. Students remain responsible for fulfilling both course and university requirements during the request process.
Please review the Criteria and Documentation section of this document for the types of events for which this request may be considered and the
documentation that must be provided and attached. Acknowledge your review by initialing here _________.
Please note that the actions below are taken only when circumstances beyond a student’s control prevent the student from completing course
drops/resignations by the official deadline as indicated on the university calendar. Select the action being requested by checking the appropriate
box below.
☐ Request to change a course from Credit to Audit. (A change to audit a course is defined as a withdrawal from and a registration as audit
into a course or courses in which a student is currently enrolled after the enrollment statistics date for that semester/session.)
☐ Late drop of course(s) (A late drop of course(s) is defined as withdrawal from a course or courses in which a student is currently enrolled
after the close of business on the date specified by the University Academic Calendar as the final date to drop a course or resign from the
University, but before the close of business on the official last day of final exams. If requesting that all courses be dropped, please select
late resignation from the University.)
☐ Late resignation from the University (A late resignation from the University is defined as withdrawal from all courses in which a student
is currently enrolled after the close of business on the date specified by the University Academic Calendar as the final date to drop a course
or resign from the university, but before the close of business on the official last day of final exams.)
☐ Retroactive drop of course(s) (A retroactive drop of course(s) is defined as withdrawal from a course or courses after the close of
business on the official last day of final exams. If requesting withdrawal from all courses, please select retroactive resignation from the
University.)
☐ Retroactive resignation from the University (A retroactive resignation from the University is defined as withdrawal from all courses
after the close of business on the official last day of final exams.)
In the event that your request is approved, list the semester this request is for and the course(s) to be dropped.
Semester ________________ Course(s) ___________________________________________________________________________
By
signing this document you are declaring that the information provided with regard to this request is true. Should your request be
approved, your signature also gives the university permission to perform the actions necessary to process the request which typically
includes the changing of each grade assigned to each course listed above to W. Your signature also declares that you have consulted with the
Office of Financial Aid and that you understand the impact of this action.
Student’s Nicholls E-mail Address Signature of Student Date
Request for Late or Retroactive Drop/Resignation
For office use only
☐ Request approved based on the following event ☐ Request denied for the following reason(s)
☐ Illness/injury ☐ Insufficient documentation
☐ Death of immediate family member ☐ Insufficient narrative
☐ National defense ☐ Documentation does not support student’s narrative
☐ Mandatory job transfer ☐ Invalid reason for request
☐ Natural disaster ☐ Other ________________________________________
☐ Other _________________________________
Comments: ___________________________________________________________________________________________________
________________________________________________________
Signature of Dean Date
Please send the original form and the student’s narrative to the Office of Records and Registration. Copies of each should be filed in the Dean’s office.
Records Office Use Only: Data Entered By: _______________
___
__________________________ Date: _____________________________
click to sign
signature
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