Administrative Withdrawal Form

Any student with no documented activity (as prescribed in the course syllabus) in a course for a period of 3 weeks may be administratively withdrawn from the course at the discretion of the instructor. This action is indicated on the transcript by the WA grade and impacts the GPA as an F.

Before You Issue the WA Grade, Consider:

Has the student been notified of this forthcoming action? Written notice is required. Email is acceptable.
1. You can suggest to the student that he or she withdraw from the course with a W (This is an instructor action, not a registrar action).
The student’s “start” date in the course. If added late, has the student been in the course three weeks?
1. Office of the Registrar can provide the date the course was added.
2. Was late-added student proactive to learn what work might be due?
3. Is attendance reporting up to date in MyInfo? This will support the decision to issue a WA.

"*" indicates required fields

Instructor Name*

First Last

Instructor Email*

Acknowledgment*

I acknowledge that my attendance is up-to-date in MyInfo and the documentation for the below student missing 3 weeks or more of class is available.

Acknowledgment*

I acknowledge that I am responsible for informing the student that I am administratively withdrawing them from my course

Student's Name*

First Last

No nicknames

Student ID Number*

Course Code and Section (ex. ENGL 1111 001*

Last Date of Attendance*

If student has never attended, please put the first day of classes.

Instructor Electronic Signature: Typed*

I agree and acknowledge that this document can be executed electronically and it is binding in every way as if signed by my hand.

Instructor Electronic Signature: Date*