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Request for a Full Withdrawal with Extenuating Circumstances


Student Assistance and Support Services (SASS) manages the process for Full Withdrawals due to Extenuating Circumstances (WE) when the request is made during the current term for which the request applies. All Full WE requests require a consultation with the Assistant Director for Withdrawal Services or other available staff member in the SASS Office. SASS staff will review your request form once submitted and send an official letter via email to your UNC Charlotte email address. This letter will outline in detail your next steps and action items, including how to schedule the Full WE Consultation meeting and any additional requirements. Students who do not complete all steps of the Full WE process, as outlined on the Withdrawal Website, will result in your request not being processed. All questions on this form must be answered in order to accept your request form and move forward with the Full WE process.

Students should carefully review all information related to the Full WE process, deadlines, and implications prior to submitting a request form.

You should not fill out this form if any of the following reasons applies to your withdrawal request:

  • You have already self-withdrawn from your classes for the current term
  • Your primary reason for wanting a withdrawal is due to you failing a class or not doing well (with no other extenuating circumstances)
  • You are wanting a withdrawal for a term other than the current term (please review the process for submitting an academic petition for a late withdrawal, as SASS cannot assist with requests for previously completed terms)
  • You are transferring or leaving the University after completing the current semester

Contact Information

Please complete all fields. Requests cannot be processed if all fields are not complete.

 
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Student Information

Please provide your name and student ID number. Please verify that your 9-digit ID number is entered correctly. Requests cannot be processed if all fields are not complete.

Involved party 1

Required Questions

Please answer the questions below.

What is the nature of your extenuating circumstance(s) that has prompted you to request a Full Withdrawal with Extenuating Circumstances? You can check multiple reasons, if applicable to your situation.(Required)
You must make at least one selection.
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I am requesting a Full Withdrawal with Extenuating Circumstances (WE) from all classes for the current semester. I understand that the approval for a Full WE may include some treatment expectations during my time away from the University depending on the specific nature of my extenuating circumstance(s), for example, medical.(Required)
You must make at least one selection.
My request will not be processed until all supporting documentation has been received. It is my responsibility to contact my medical provider to complete the Health Evaluation Form, if it is needed to support my request.(Required)
You must make at least one selection.
My request will not be processed if I do not schedule AND attend a consultation with the Assistant Director for Withdrawal Services or available SASS staff member.(Required)
You must make at least one selection.
I acknowledge that approval for a Full Withdrawal with Extenuating Circumstances (WE) may have various implications on my student account, student status, and/or various contracts I hold with specific offices on campus. These implications may extend to: Financial Aid, Housing, Dining, Parking, Student Health Insurance, access to services at the Student Health Center and/or Counseling and Psychological Services, Tuition Refund Status, Visa Status, Graduate Student Status, Veteran Student Status, Readmission to the University, and/or various experiential or learning communities. I also understand that it is my responsibility to follow up with any appropriate offices or departments if I require additional information that cannot be answered directly by the Office of Student Assistance and Support Services to help better inform my decision to withdraw from the semester.(Required)
You must make at least one selection.
I am responsible for any outstanding debt to UNC Charlotte. I also understand that money may be owed back to UNC Charlotte and it is my responsibility to contact Financial Aid, Housing and Residence Life, Dining Services, Office of the Bursar (Tuition), and/or any other applicable offices to determine what that amount may be. I understand and assume all responsibility for any and all potential charges and/or fees.(Required)
You must make at least one selection.
Failure to supply truthful, adequate, and complete information on this request form or in any supporting documentation submitted to Student Assistance and Support Services will result in denial of the request and may be forwarded to the Office of Student Accountability and Conflict Resolution for review.(Required)
You must make at least one selection.
If approved for a Full Withdrawal with Extenuating Circumstances (WE), I will be required to complete the Petition to Return process before I can register for classes in a future semester. I understand that after the self-withdrawal deadline (60% completion of the semester) has passed, the majority of Full WEs approved for medical reasons will last through the current semester plus one additional semester.(Required)
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Supporting Documentation

Please upload any supporting documents that are relevant to your extenuating circumstances. It is recommended that documentation be submitted in PDF format, wherever possible, to ensure that staff can appropriately open and view your documents. A completed Health Evaluation Form is required for any requests due to a medical/mental health reason. Note: Health Evaluations should be faxed or mailed directly to Student Assistance and Support Services by the medical provider. We cannot accept health evaluations from students. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission