Excused Withdrawal Due to Extenuating Circumstances Request Form

This form is for students who are requesting to withdraw from all or some of their courses during a single term due to non-COVID-19 related extenuating circumstances.

Students withdrawing from all of their courses due to COVID-19 must complete the COVID-19-Related Withdrawal Supplementary Form.

Student Information

Student ID

First Name

Last Name

MUIH Email

Phone Number

Advisor Name

Trimester Withdrawing From

Are you requesting to withdraw from all courses this trimester?

Course Information

Courses withdrawing

Course Number (ex. NUTR 600)

Section (ex. 200)

Credit Hours

Courses remaining enrolled

Course Number (ex. NUTR 600)

Section (ex. 200)

Credit Hours

Do you intend to return?

Extenuating Circumstance during the term requesting excused withdrawal

Are you interested in learning more about student support services you may continue to qualify for now or as you resume courses? These include career counseling, academic coaching, mental health counseling, and disability services.

Please state your specific reason for the request and any details you wish to be considered. If you are requesting a partial withdrawal, please include why only the specific course(s) is/was impacted. Decisions will be rendered based solely on the information you provide in this form and the associated documentation.

Please attach all relevant information or recent supporting documentation for this request. Requests without verifiable third-party supporting documentation will be denied.

Additional Information

Submission of this request does not guarantee approval. Students must withdraw from their course(s) prior to submitting this request. If the withdrawal(s) is/are approved due to extenuating circumstances, the "W" will be converted to an "E" (Excused Withdrawal Due to Extenuating Circumstances) grade.

Extenuating circumstances are recent unforeseeable situations beyond your control that have a severe impact on academic performance. This circumstance(s) must have occurred during the term for which you are requesting an excused withdrawal.
Permanent health conditions generally do not apply to this policy but may qualify for disability-related accommodations which are provided by the Office of Disability Services and Accessibility. A serious, unforeseeable increase in disability, however, may qualify for an excused withdrawal if there is a documentation of the disability AND recent documentation of an increase in disability with potential serious impact on academic performance during the term in which this request is submitted. Health-related documentation must be provided by a qualified professional.
The following reasons do not apply to this policy: technology challenges, minor illnesses/injury, childcare, family issues, job changes, holidays, transportation issues, and avoiding a failing grade due to academic issues.
If approved, University records will indicate that your approved withdrawal is excused. This means that you withdrew from courses due to specific events beyond your control that severely affected your ability to complete the course(s).
Students are advised to complete this form within 2 business days of receipt from their Academic Advisor. Generally, excused withdrawals are not retroactive; however, exceptions will be considered by the Dean of Student Affairs on a case-by-case basis.
Students must complete this request and submit recent verifiable, third-party documentation within the term for which the student is requesting excused withdrawals. Requests without this documentation will be denied.
We recommend that all students considering a withdrawal consult with their academic advisor and Financial Aid (if applicable)
Notification of outcome will be provided within 3-5 business days.

STUDENT CERTIFICATION OF EXCUSED WITHDRAWAL REQUEST

By signing below, I certify that all information I provided on this petition is legitimate and accurate. I understand that I have been advised to consult with my academic advisor and Financial Aid (if applicable) before submitting this form.

Student Signature

Date