OFFICE OF THE VICE PROVOST FOR UNDERGRADUATE EDUCATION
REQUEST FOR EXCEPTION TO COURSE WITHDRAWAL DEADLINE
Complete Section A and have your instructor complete Section B. Submit completed forms to the Office of the Vice Provost
for Undergraduate Education in Lecture Center 30 or via academicstanding@albany.edu. You will be notified of the decision
of the Committee on Academic Standing via e-mail. Please use a separate form for each individual course. If approved, a
processing fee will be collected by the Registrar’s Office ($20 per transaction). You will have ten (10) business days from the
approval date to take action. If you do not, you will have to petition again.
Making false statements and/or filing forged documents and/or submitting false material to a University committee
violates the standards of academic integrity. Such violations will be subject to appropriate disciplinary action.
------------------------------------------------------------------------------------------------------------------------------------ --------------------SECTION A. Name________________________________________________ ID Number_________________________
E-mail Address____________________________________________________ Phone Number_____________________
Instructor
Course Subject: (AHIS)
Catalog # (100)
Class #: (2497)
Credits: (3)
Term: (Spring) Year: (2015)
Please submit a written statement indicating why you feel you should be granted an exception to the deadline for the last day
to drop this particular class, and why you missed the published deadline. Documentation to support your petition must be
submitted for review. Being unaware of the policy or deadline, changing your mind because of poor test results or unfulfilled
class expectations, after the deadline, will not qualify as a policy exception.
This is a request for an exception. There should be no expectation that your petition will be approved.
If your petition is approved, you will be notified by email.
☐ I understand that enrollment changes may impact my eligibility for financial aid for current and/or future terms. I have contacted the
Office of Financial Aid (Campus Center G-25 or 518-442-3202) to inquire how a late withdrawal will affect my aid.
☐ I understand I should continue to participate in coursework pending the results of this petition.
☐ I understand that if approved, I will have ten (10) business days from the approval date to take action. If not, I will have to petition
again.
☐ I understand that no other individuals may request information pertaining to this petition or the materials submitted in support (e.g.,
parents, guardians, etc.). All matters will be kept confidential between the Committee on Academic Standing, the Office of the Vice
Provost for Undergraduate Education, and necessary University representatives with a legitimate educational interest that the Committee
deems appropriate.
______________________________
_______________
Student’s Signature
Date
SECTION B. TO BE COMPLETED BY INSTRUCTOR
1. Student [ ] is still attending. [ ] stopped attending on __________________.
2. Student [ ] has or [ ] has not received any grades or other evaluations. If yes, please indicate dates and grades:
___________________________________________________________________________________________________
3. Comments (you may use this form, e-mail comments to academicstanding@albany.edu, or submit them to the Office of
the Vice Provost for Undergraduate Education in Lecture Center 30):
_____________________
_____________________________
__________
Print Instructor’s Name
Instructor’s Signature
Date
SECTION C. COMMITTEE ON ACADEMIC STANDING
[ ] Request approved. ($20 processing fee will apply for each transaction).
______________________________
For the Committee on Academic Standing
_______________
Date
[ ] Request not approved. Grade remains.