Fillable Request-exception-form1 - Exceptions Form

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Request-exception-form1 - Exceptions Form

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Instructions for Submitting a Request for an Exception:
Students submitting a Request for an Exception are subject to Policy 170.72 Course Withdrawal. Please note that submission
of a request will not act as a withdrawal from ongoing classes. If you have any questions, please consult an advisor or refer
to the relevant UMGC webpage.
A complete request must include the following:
1
. Completed, signed and dated Request for Exception Form; and
2. A TYPED detailed personal statement (please limit this to 1 page); and
3. Relevant and supporting documentation that pertains to the time period at issue.
Incomplete requests will be closed and denied but may be re-opened once the required documentation is
submitted.
A Request for an Exception must meet the following Criteria:
• All requests for exception to the UMGC Course Withdrawal Policy must be submitted within 90 days from the last.
day of the term duri
ng which the circumstance occurred.
• A direct “cause and effect” relationship can be demonstrated between the extenuating circumstances and the student’s
ability to successfully complete his/her course(s).
• Circumstances experienced and their resulting impact were unforeseeable and/or could not have been reasonably
prevented during the time period in question.
• Relevant documentation can be furnished from an appropriate authority to support the claim. Documentation must
be signed and on official letterhead of the issuing authority and include the contact information for this authority. See
below for examples of supporting documentation.
Reason
Examples of Relevant and Supporting Documentation
Medical Issue
A signed letter from physician/medical provider stating 1) the date(s) of the onset and duration of the condition and
2) how the condition impaired your ability to continue/complete courses.
Please do NOT send medical records or bills.
Military Duty
Deployment Orders/PCS Orders/TDY Orders; Memo from Commanding Officer to address issues not covered by
military orders. Generally we require memos from O-5’s and above.
Death of Immediate
Family Member
Death certificate or obituary. The submitted documentation must show date of death and family relationship.
• The following issues cannot be addressed through the Request for Exception Process:
§ Satisfactory Academic Progress (SAP) appeals under Policy 220.32 and Policy 220.33.
§ Disputes regarding the denial of financial aid or the amount awarded.
§ Alleged Arbitrary and Capricious Grade appeals under Policy 130.80.
§ Complaints about class instruction or curriculum. Please contact the relevant academic department.
Please email, fax, or mail your Request for Exception form to:
Email:
Request for Exceptions –
exception.request@umuc.edu
Fax:
240-684-2547
Address:
Office of the Registrar
Largo I Building
3501 University Blvd East
Adelphi, MD 20783
The Office of Registrar sends all communications pertaining to your request via email. If you would like to change
your main email address, log in to MyUMGC portal, click Student Center and scroll down to Personal Information.
Please note that students are responsible for keeping their personal information, including email addresses, up to date.
Want to know the status of your request? Email us at exception.request@umuc.edu.
NOTE: SUBMISSION OF A REQUEST DOES NOT SUSPEND BILLING OR STOP COLLECTIONS ACTIVITY
REQUEST FOR EXCEPTION
FORM
UMGC Course Wi thdrawal Policy
Student
Name
(Last,
First):
Student
ID:
o Undergraduate o
Military
Undergraduate o Graduate o
Military
Graduate
*
The
Office of the Registrar sends all communications via the e-mail address on record.
If
you are using an e-mail address different
from
the one currently on record with UMGC, please update your e-mail address per the
“Instructions for Submitting a Request for an
Exception.”
Semester:
o
Fall
o
Wi nter
o
Spring
o
Su mmer
Y
ear :
SUBJECT
COURSE #
SECTION #
WITHDRAWAL DA
TE
(if
applicable)
REGISTRATION CENTER
(only applicable for Europe/Asia
students)
Action Requested:
o
Academic Withdrawal
(“F”
or
“FN”
to
“W”) o
Academic Withdrawal and Tuition
Refund
o
Re-open a previously DENIED request
(time limit is 30 days from the date of your initial
decision)
*
The grade of
“W”
cannot be removed from your
record.
*
Notice to Financial Aid and Veterans Administration Benefits recipients: any changes in enrollment may result in a retroactive adjustment
in financial aid and/or benefits
awarded.
Required Documentation:
o
This completed, signed, and dated Request for Exception Form;
and
o
1-page typed detailed personal statement;
and
o
Relevant and supporting documentation that pertains to the class period at issue. For
additional guidance,
please refer to “Instructions for Submitting a Request for an
Exception.”
Additional Information
(Please attach your personal statement
separately
.)
By signing my name,
I
certify that the information presented is true to the best of my
knowledge.
Student
Signature:
Date:
Please allow
approximately
six to eight weeks
from
the
time
of submission of all
documentation.
NOTE:
SUBMISSION
OF A REQUEST DOES NOT SUSPEND BILLING OR STOP COLLECTIONS
ACTIVITY
.
OFFICE OF THE REGISTRAR
|
LARGO
I
BUILDING
|
3501 UNIVERSITY BOULEVARD EAST
|
ADELPHI, MD 20783
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Completed 3 November 2019

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