PETITION TO WITHDRAW AFTER THE END OF THE TERM (Revised Autumn 2014) ________________________________________________________________________________________ Office of the Registrar 201 Lommasson Center Missoula, MT 59812 NOTE: The Dean has final approval or denial of retroactive withdrawal for the last semester in attendance provided the request is received before the end of the student’s next semester of attendance. For retroactive withdrawal from any other semester, the Withdrawal Committee has final approval or denial of the request. NAME:________________________________________________________ID:______________________ Major(s):______________________________________________Minor(s):__________________________ Address:____________________________________________Phone Number_______________________ City:_________________________________________________State:_________________Zip:_________ 2. Semester(s) from which you wish to withdraw: ________________________________________________ 3. Reason for withdrawal should be typed on a separate sheet. Attach any relevant documentation. 4. Student’s Signature __________________________________________________DATE______________ 4A. International student? If yes, Foreign Student Services Signature required: ________________________________________________________________DATE_____________ 4B. Receiving Veteran benefits? If yes, VETS Office Signature required: ________________________________________________________________DATE_____________ 5. Advisor Signature_____________________________________________________DATE_____________ Approval Recommended_______ Remarks: 6. Department Chair* Signature____________________________________________DATE_____________ Approval Recommended_______ Remarks: 7. Approval NOT Recommended_______ Approval NOT Recommended_______ Dean* Signature_______________________________________________________DATE____________ Approval Recommended_________ Remarks: Approval NOT Recommended_______ ------------------------------------------------------------------------------------------------------------------------------------------------8. Withdrawal Committee DATE_________________ Approved _______ Remarks: Denied_______ *Undergraduate Non-Degree and Undeclared students need signature of the Director of The Office for Student Success