• I have aached oﬃcial documentation of extenuating circumstances or Appendix A has been completed by an appropriate
professional as listed in Policy E2011. (For documentation not in English, I have included copies of the original documents
and oﬃcial/notarized translations.)
2. REQUIREMENTS CHECKLIST
All appeal submissions require a completed appeal form, a leer of explanation, and documentary evidence of extenuating
circumstances. Please conﬁrm that you have met the criteria outlined below before submiing your appeal.
Incomplete appeals will not be reviewed.
• I have aached a leer ex
plaining the circumstances that prevented me from meeting deadlines, the purpose of my appeal,
and a clear statement indicating my desired outcome (one page minimum).
• My Langara student account is in good standing (i.e. no holds/outstanding fees). Some exceptions apply. Please contact
firstname.lastname@example.org if you have questions.
Full legal name:
Student Appeal Request Form (Conﬁdential)
All correspondence regarding your appeal will be sent to your preferred email on ﬁle and/or your Langara email. Students
are responsible for updating their contact information in the Student Information System prior to submiing an appeal.
I conﬁrm that my contact information is up to date in the Student Information System and that I understand all
correspondence regarding my appeal will be sent to my preferred email and/or Langara email.
3. TYPE OF APPEAL
REGISTRAR & ENROLMENT SERVICES
1. STUDENT INFORMATION
Page 2 of 4
1. Course Withdrawal (select one below and complete section 4)
Withdrawals requested aer withdrawal deadline, but before the last day of classes:
2. Other (please specify):
Complete Late Course Withdrawal – all courses in current semester are withdrawn
Partial Late Course Withdrawal – a selection of courses in current semester are withdrawn
Both the student and an appropriate professional must submit documentation that supports why one or
more courses are aﬀected and why the other(s) are not. Doing well in one course but failing at another is
not viewed as a valid reason.
Retroactive Course Withdrawal – a complete withdrawal from all courses in previous semester(s)
Retroactive withdrawal requests will only be considered for courses students were registered in for the
previous six semesters.
Withdrawals requested aer the last day of classes of aﬀected semester: