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