You must have JavaScript enabled to use this 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 - Select -Dr.Mr.Mrs.Ms. First Name Last Name Email Address of Referring Instuctor Submitting Person's Email Address More If someone other than the referring instructor or dean is submitting this form, then please enter your email address. School of - Select -Frank S. Groner School of Professional StudiesFred Hale School of BusinessChristian StudiesCommunication and Performing ArtsEducationHumanitiesNatural and Social SciencesNursing General Student Information Student Contact 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 Select One - Select -MWFTROther…(please explain) Other…(please explain) 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 More This form will automatically be sent to the specified Dean for approval. Date and Time Submitted Thursday, December 18, 2025 - 04:13
