3600 M Street, Stop 13
REQUEST FOR EXCUSED WITHDRAWAL (
EW) FOR FALL 2020 DUE TO COVID-19
Return Form to the Admissions and Records Office by emailing: admissions@mccd.edu Incomplete or illegible form
s will not be processed
Note: this request is specifically for classes taken in fall 2020, which were dropped due to the COVID-19 pandemic. To petition for an EW grade for any other semester, please use the
standard EW Excused Withdrawal form. Petition forms are available at http://www.mccd.edu/res
ources/admissions-records/forms.html/
Name: ______________________________________________
Last First Middle
Student Email: ___________________________________________
Address: ___________________________________________
□Fall □ Spring xSummer 2020 Year
MC Student ID# ______________________
Phone (____)
_________________________
_____
____
__________________________________
__________
_________________________________
I request an EW grade (excused withdrawal for the following classes:
Tuition refunds may be available, in this unprecedented scenario, if not originally waived by specific types of financial aid.
□ I would like to request a refund of tuition fees for the classes listed above, if available.
□ I do not request a refund of tuition fees for the classes listed above.
I, the student, understand that this request will make a permanent grade change on my transcript for the class(es) listed above. I understand EW grades do not affect
my grade point average (GPA), and will not be counted toward progress or academic probation and dismissal. In addition, extenuating circumstances caused by
COVID- 19 may be excluded from the Satisfactory Academic Progress (SAP) policy for financial aid purposes. The college has made this option available to students in
the best interest of their academic records, in response to COVID-19, yet cannot account for all future scenarios. By signing below, I acknowledge and accept the
information provided to me on this form.
Student signature: ______________________________________________ Date: _____________________________
****************************************FOR OFFICE USE ONLY **************************************************
Approved Effective: ________________________ Denied: _______No documentation or inadequate documentation
_______Does not meet criteria for EW for COVID-19
Comment: __________________________________________________________________________________________________
Petitions Committee Signature ________________________________ Date: __________________ Processed by _______________
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