Petition to Withdraw from a
Course after the Deadline
The deadline to withdraw from a course is the Friday of the 10th week of the Fall and Spring semesters,
the first Wednesday of Summer Session 1, and the first Friday of Summer Session 2. Exceptions to the
deadline are not granted routinely. However, extenuating circumstances are petitionable and will be
considered on a case by case basis. For your petition to be considered, you must demonstrate there
are/were non-academic extenuating circumstances beyond your control that prevented you from
abiding by the above stated deadlines (e.g., serious injury or illness, death in the immediate family, etc.).
Documentation of these extenuating circumstances should be described in detail below.
Date of Request:
Name:
UIN:
College:
Department:
Mailing Address:
UIC E-mail:
Phone:
Please answer the following:
1. Semester/Year Course Taken In:
Course Rubric & No.:
CRN:
Instructor’s Name:
Instructor’s Email:
2. Have you met with your instructor to discuss all your options?
Yes
No
3. Have you met with your academic advisor to discuss all your options?
Yes
No
4. If you are doing poorly in the class, have you sought tutoring?
Yes
No
Please thoroughly describe your current status in the course, what attempts you have made for
improvement, and how many classes or assignments you have missed:
5. Do you understand that a “W” will appear on your record for this course?
Yes
No
6. Have you withdrawn from any classes in a previous term?
Yes
No
7. If you requested a withdrawal in a previous term, did you fill out a petition?
Yes
No
8. Do you understand you are responsible for tuition and fees assessed for this course? Yes
No
9. Do you receive financial aid?
No
Yes
10. If you do receive financial aid, have you checked with the Office of Financial Aid to see how
withdrawing from this course will affect any future financial aid?
Yes
No
11. Are you an athlete with a scholarship?
Yes
No
12. If you are a scholarship athlete, have you checked how a withdrawal would affect your eligibility?
Yes
No
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Please explain the extenuating circumstances causing you to request dropping this course. Academic
performance, change of major, no longer needing the course, potential loss or gain of financial aid and/or
scholarship, etc. are not acceptable reasons for course withdrawal. Petitionable requests include things
such as serious personal medical issues and/or significant issues in your immediate family. Everything
described below must be accompanied by authorized documentation. It is critical that your
statement be well thought out, well-written, and typed below. Your explanation should be thorough,
detailed, and fill this entire page or come very close to filling this entire page, minimally.
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I agree that I have read and answered all of the questions listed above to the best of my ability
I agree to attend and participate in the above mentioned course until I am informed of a decision
on my petition.
I understand my petition will be reviewed by a committee and that I will be informed about the
decision via my UIC email only.
If my request is denied, I understand I must complete the course to the best of my ability.
If applicable, you are encouraged to seek counseling support at the Student Counseling Center,
SSB, Suite 2010.
Student Signature:
Date:
*NOTE: By typing your name here, you are agreeing to everything stated above.*
Email your completed form to the Academic Advisor, Emily C. Walker at ecwalker@uic.edu.
It will be routed to Undergraduate Director upon receipt.
To be completed by an Academic Advisor:
Current GPA:
No. of withdrawals:
Academic Status:
Comments:
Recommendation to KN Director and Assistant Director of Undergraduate Studies:
Director’s Decision
Request Approved: Yes
No
KN Director of Undergraduate Studies:
Date:
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