Fillable Term-withdrawal-request Term Withdrawal Form_2016_08_26.pdf

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Term-withdrawal-request Term Withdrawal Form_2016_08_26.pdf

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Term Withdrawal Form
Term withdrawal forms must be received no later than 30 days
after the end of the semester in which the withdrawal is requested.
Enrollment Management
R
egistrar's Office
One University Drive
Camarillo, CA 93012
Phone: (805) 437-8500
First Name Last Name Student ID
Phone
Term
6WDWHreason forwithdrawal and attach appropriate supporting documentation (required):
Student's Signature:
Date:
.FFUTDSJUFSJBGPSTerious and compelling reasons4FOEUP%FBO
Circumstances not beyond
student's control or serious and compelling3FUVSOUPTUVEFOU
Appropriate verifying documentation not provided3FUVSOUPTUVEFOU
Da
t
e:
Date:
%FBO PS Designee
CARE Team Re
port Submitted:
Notification Sent:
NSC Updated:
Class
Number
Subject
Course
Number
Section
Number
Units
Instructor/Designee
Signature and Date
Program Chair/Designee
Signature and Date
1234 MATH 100 02 3
Dr. Jane Doe, 11/07/17 Dr. John Doe, 11/09/17
If you are unable to come to campus and need assistance with the withdrawal process, please contact the Registrar's Office at (805)437-8500 or records.registration@csuci.edu.
Student Checklist
____EQWHUyour LQIRUP
DWLRQall FRXUVHLQIRUPDWLRQand ZLWKGUDZDOUHDVRQbelow.
____AWWDFK required VXSSRUWLQJGRFXPHQWDWLRQ Your request will
not be processed if you fail to submit supporting documentation.
____2EWDLQLQVWUXFWRUDQGSURJUDPFKDLUVLJQDWXUHV (e.g. Math chair for a Math class) for each course.
____6LJQDQGVXEPLWFRPSOHWHG7HUP:LWKGUDZDO)RUPWRWKHRegistrar's Office via e-mail, by mail, or in person to the Enrollment
Center in Sage Hall You will be notified of the final decision via your dolphin e-mail account. "W" grades will be recorded for approved
withdrawals.
Registrar's Office Designee
WWZKs
E/
$GPLQLVWUDWLYH8VH2QO\
7\SHRI:LWKGUDZDO0HGLFDO)LQDQFLDO2WKHUBBBBBBBBBBBBBBBBBBB /DVW'DWHRI$WWHQGDQFHBBBBBBBBBBBBBBBBBBBBB
Initials/Date:
7HUPWithdrawal )RUP
Withdrawal Process:
1.
During the fourth week of the term, complete the Term Withdrawal )RUP, obtai
n instructor and program chair signatures, and submit to the
Enrollment Center for processing. A withdrawal from all courses will be routed to your College 'HDQ for review.
2.
After the fourth week of the term, withdrawal from courses is permissible only for serious and compelling reasons. If you meet the criteria,
complete the Withdrawal Petition, obtain instructor and program chair signatures, and submit to the Enrollment Center.$
ZLWKGUDZDOIURPDOOFRXUVHVZLOOEHURXWHGWR\RXU&ROOHJH'HDQIRUUHYLHZ
NOTE: If you are unable to come to campus and need assistance with the withdrawal process, please contact the Registrar's Office at
(805) 437-8500.
Notification Process:
Approved Petitions: The Registrar's Office will process the withdrawal and notify the student via dolphin e-mail account. Once you
have received notification, you are encouragedWR verify your account status and financial aid status. Any change to your enrollment could
affect your financial obligation to the University.
Denied Petitions: 6WXGHQWV QRW PHHWLQJ SROLF\ FULWHULD ZLOO EH QRILLHG YLD GROSKLQ HPDLO DQG ZLOO KDYH WKHLU GRFXPHQWV UHWXUQHG
WR WKHP Students will be notified via dolphin e-mail of denied petitions. The Withdrawal )RUP will be retained in the student's academic record.
Policy on Withdrawals (SP 13-10):
1.
Undergraduate students may withdraw from no more than 18 semester-uni
ts.
2.
Students may drop courses through the relevant published deadline without instructor permission. The published deadlines
will correspond to 20% of the instructional time for the course.
3.
After approximately 20% of instructional time and until 80% of instructional time has elapsed, withdrawal from courses is
permissible only for serious and compelling reasons. Approval signatures from the instructor and program chairs must be obtained to withdraw
during this period. The withdrawal will be noted as a “W” on the student's permanent record.
4.
Students wishing to drop courses after the published deadline must comply with the Criteria for “Serious and Compelling
Reasons.”
5.
After 80% of instructional time has elapsed, withdrawal is not permitted except in cases beyond the student's control such as accident or serious
illness where the assignment of an Incomplete is 6. not practical. Approval signatures from the instructor, program chair and &ROOHJH'HDQ (or
designee) must be obtained. Withdrawal in this category will typically involve total withdrawal from the University and will be noted as a “W” on the
student's permanent record. Such withdrawals will not count against the maximums provided for in item 1above.
Criteria for "Serious and Compelling" Reasons
Examples of "Serious and Compelling" Reasons:
- An extended absence due to a verifiable accident, illness, or personal problem serious enough to cause withdrawal from the University.
- And extended absence due to a death in the immediate family. This applies to absences exceeding a week due to family affairs that must be attended.
- A necessary change in employment or financial status that interferes with student's ability to attend class. Student must submit employer verification.
- Active military duty. A copy of "orders" must be provided.
The following situations are not "serious and compelling" reasons:
- Grade anticipated in class is not sufficiently high, or student is doing failing work.
- Failure to attend class, complete assignments, or take a test.
- Dissatisfaction with course material, instructional method, or instructor.
- The class is more difficult than expected.
- Pressure of other classes, participation in social activities, or simple lack of motivation.
- A change of major or minor.
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Completed 12 March 2020

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