Undergraduate Advising & BDIC
Academic Dean’s Office
613 Goodell Building
University of Massachusetts
Amherst, MA 01003
413-545-2191 (phone)
413-577-6300 (fax)
LATE COURSE WITHDRAWAL GUIDELINES
For Undeclared or NXCHNG Students
TO THE STUDENT:
The Academic Dean RARELY grants permission for students to withdraw from a course after the midsemester deadline. To proceed with the process, carefully consider the following:
 The Dean’s Academic Review Committee will comply with the following University Academic
Regulation: “After the mid-semester deadline, an academic dean can grant a student permission to
withdraw from a course with a “W” when documented extenuating circumstances beyond the student’s
control have interfered with his/her ability to complete the work in the course.”
 Your request will go to the Dean’s Academic Review Committee only once all paperwork has
been submitted; Approval is not automatic.
 SUBMIT ALL MATERIALS to the Academic Dean’s Office in 613 Goodell - Hours TBD. If you plan to
forward some of the documentation to the office, please indicate how it will be sent.
 In accordance with HIPPA regulations, all official medical documentation supplied as part of an
academic petition will be shredded after a decision has been made in the case. Please do not submit
original documents.
NOTE: Poor Academic Performance does NOT constitute grounds for a late course withdrawal.
You will receive notification of the decision via UMass email, typically within one week after
submission of all required paperwork.
YOUR PETITION PAPERWORK MUST INCLUDE:
Part 1 – Student Information Form (attached)
Part 2 – Completed Course Change Request form
Part 3 – Your Personal Statement typed, including a detailed explanation for why you
missed the deadline and why you should be granted a late course withdrawal. You need to
discuss how the situation/issue has affected your performance in the course, and if it's an ongoing
issue, how you are being proactive about resolving the issue or seeking help to manage it.
Part 4 – Documentation of your extenuating circumstances. Examples include:
(1) Personal illness - Information on the severity of the illness and dates of treatment from your
personal physician. If you were treated at University Health Services (UHS), you can contact them
at 413-577-5114 to discuss arrangements to document your illness for your appeal. If you were
treated elsewhere, your health care provider should send a letter to the dean on official stationery.
(2) Personal and/or family problems - Description of the problem from a counselor, Dean of
Students, clergy member, or family member(s), etc. If you were treated at Mental Health Services,
you should sign and return to MHS a Release of Mental Health Information Form, which can be
obtained online at http://www.umass.edu/uhs/accesstocare/forms/. The MHS fax number is
413-545-9602.
The Dean will call the MHS Director to confirm whether or not there is support for your request for
special consideration. No information about your condition will be released. If you were treated
elsewhere, your provider should send a letter to the dean on official stationery.
NOTE: The Dean’s office will also contact your instructor for a record of your
attendance and performance in the class.
Undergraduate Advising & BDIC
Academic Dean’s Office
613 Goodell Building
University of Massachusetts
Amherst, MA 01003
413-545-2191 (phone)
413-577-6300 (fax)
PART 1 -LATE COURSE WITHDRAWAL PETITION
STUDENT INFORMATION FORM
For Undeclared or NXCHNG Students
Before submitting this petition please consider:
(1) the implications of a late withdrawal on your financial aid, health insurance, car insurance, or
scholarship if this means you will drop below 12 credits (full-time status)
(2) the possibility of arranging an incomplete with your instructor if you are passing the course.
(3) the possibility of changing the course to Pass/Fail grading if it is before the midpoint of the
semester when this is still allowed if you believe you can pass the course.
1. STUDENT INFORMATION
Name:
UMass Email:
Local Address:
City/State/Zip:
Local Telephone/Cell Phone:
Class Year:
Major:
Student #:
2. COURSE INFORMATION
Department:
Course # / Section#:
Title:
Instructor:
Semester:
Reason for Request:
Personal Medical/Mental Health Other
Student Signature: _________________________________ Date: ______
------------------------------------------------ DEAN’S DECISION------------------------------------------Date________________
Initials_______________
Approve/ Deny / Table
COMMENTS:
August 2015