COLLEGE OF DUPAGE
Student Registration Services, SSC 2221
Phone (630) 942-2377
Fax: (630) 942-2878
Email: Registration_forms@cod.edu
LATE WITHDRAWAL APPEAL FORM
Rcvd by:_________
(NO CONSIDERATION WILL BE GIVEN FOR ACADEMIC REASONS)
Date____________
______________________ ___________________
Date
Term
____________________________________________________________________________________________________________
Student’s Name: Last, First, Middle Initial (Please PRINT clearly.)
C.O.D. Student ID Number or SSN
____________________________________________________________________________________________________________
Street Address (Include Apt. Number if applicable)
_____________________________ _ _______ ______________
ZIP Code
City
State
________________________
Phone Number
__________________________
Email Address
____________________________________________________________________________________________________________
Course Name and Section
Instructor’s Name
____________________________________________________________________________________________________________
Course Name and Section
Instructor’s Name
____________________________________________________________________________________________________________
Course Name and Section
Instructor’s Name
____________________________________________________________________________________________________________
Course Name and Section
Instructor’s Name
To the Student: You are required to provide supporting documentation with your request.
□
I will be submitting supporting documentation via fax (630-942-2848) or email (registration_forms@cod.edu)
immediately after submitting this form. My documentation will include my name and College of DuPage ID number.
Please explain: Why you did not withdraw from your class(es) during the designated period.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Student’s Signature
For Registration Office Use Only
Date
Decision:
Initials:
(Over)
Date:
Guidelines for Requesting a Late Withdrawal:
•
If the appeal is due to medical reasons, the student must complete a Request for Medical Withdrawal,
which can be obtained in the Registration Office, SSC 2221, on the College of DuPage website at:
www.cod.edu or on myACCESS at: myaccess.cod.edu. For questions regarding the Request for Medical
Withdrawal, please call (630) 942-2687.
•
Issues regarding Non-Credit, Kids on Campus, Teens on Campus, Adult seminars, workshops and classes
should be addressed to the office of Continuing Education, SRC 1110 (630) 942-2208.
•
Late Withdrawal Appeals must be submitted at least one day prior to the last regular class meeting.
Students will not be eligible to petition for late withdrawal during the week of Final Exams.
•
Students are required to provide documentation for all requests for late withdrawal. Appeals for late
withdrawal may be granted under extenuating circumstances only. All requests for late withdrawal must be
fully documented.
•
Students who withdraw from a class by late withdrawal appeal will not be eligible for refund of tuition or
fees.
Additional Information
•
Failure to provide adequate documentation at the time of submission will result in denial of your appeal.
•
In addition to providing supporting documentation, you must provide your own explanation as to why you
are requesting a late withdrawal. Please be thorough.
•
You will be notified of the decision through your dupage.edu email within 2 weeks of your written request.
Additional time may be necessary for determining last day of attendance.
•
A late withdrawal cannot be considered when an instructor has given a grade. If you have received a
grade of “F” for the class in question, you must submit a Petition for Failing Grades with the Records Office
before your Late Withdrawal Appeal can be considered. If the Records Office determines that you can be
withdrawn from the class in question, you will then be considered for a late withdrawal by the Registration
Office. If you have any questions regarding the ‘Petition for Failing Grades’ form, please contact the Grades
Department at (630) 942-2440 or (630) 942-2445.
RETURN COMPLETED FORM WITH ATTACHED DOCUMENTATION TO THE REGISTRATION OFFICE, SSC 2221 or email the
form and documentation to: Registration_forms@cod.edu or mail to the address below.
Attn: Late Withdrawal Appeals
College of DuPage
Student Registration Services, SSC 2221
425 Fawell Boulevard
Glen Ellyn, IL 60137
(630) 942-2377
FAX: (630) 942-2878
U:Home\Shared\Registration\Forms
Revised 03/21/16