XF Information Form

Please check this box to indicate your understanding that you may not complete this form after the last date to withdraw from your class has passed.

From

Title

First Name

Last Name

Submitting Person's Email Address

If someone other than the referring instructor or dean is submitting this form, then please enter your email address.

School of

General Student Information

Student Last Name

Student First Name

Student email address

Advisor's Name

Professor Teaching Course

Team Name (if applicable)

Course number

Course Name

Select One

Dates of Absences

Last Date Attended Class

Current Grade in Course | Please use a number instead of a letter

Email Address of Dean over specified course

This form will automatically be sent to the specified Dean for approval.

Date and Time Submitted Thursday, September 10, 2026 - 17:00