Enrolment Services
Request for Academic Consideration
Submit this completed form with supporting documentation and personal letter to your Program Counselling
Office. Refer to the complete list of Program Counsellors
for office locations and contact information.
Last Name: First Name:
ID Number: Degree Program & Major (e.g., BA History, etc.):
Phone Number: UofG Email Address:
Indicate below the type(s) of action requested (at the semester or course level) and, if applicable, the affected course(s).
The options are explained in the Academic Calendars (Undergraduate Calendar and Diploma Program Calendar
).
Semester
(e.g., F17)
Course(s), If Applicable
(e.g., BIOL*1090)
Type of Request
Semester Withdrawal Continue on Probation
Other:
Deferred Condition (Outstanding Term Work) Date Missed:
Deferred Final Exam Date Missed:
Supplemental Privilege
Late Drop Withdrawal with Failure
Deferred Condition (Outstanding Term Work) Date Missed:
Deferred Final Exam Date Missed:
Supplemental Privilege Late Drop Withdrawal with Failure
Deferred Condition (Outstanding Term Work) Date Missed:
Deferred Final Exam Date Missed:
Supplemental Privilege
Late Drop
Withdrawal with Failure
Deferred Condition (Outstanding Term Work) Date Missed:
Deferred Final Exam Date Missed:
Supplemental Privilege
Late Drop
Withdrawal with Failure
Deferred Condition (Outstanding Term Work) Date Missed:
Deferred Final Exam Date Missed:
Supplemental Privilege
Late Drop
Withdrawal with Failure
For the purpose of scheduling deferred tests/exams, please indicate if you write your tests/exams with Student
Accessibility Services: Yes No
Personal
letter attached. Describe your extenuating circumstances, with reference to specifi
c dates that were relevant
to your academic progress, and provide an explanation of how those circumstances impacted your academics.
Original supporting documentation attached (e.g., medical, psychological, compassionate). Where applicable, please
ensure that the documentation covers the date(s) of the scheduled final exam(s) or the assignment due date(s).
Student’s Signature: Date:
For Office Use Only Date Received:
Request: Granted Denied On Hold
Office of Registrarial Services Letter Code:
Approved by: Date:
click to sign
signature
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