Office of the University Ombuds

Hardship Withdrawal Appeal Form

Below you will find the instructions and fillable online form for the hardship withdrawal appeal process. This form may also be downloaded and filled out in hard-copy form (Word document) here.

Instructions

Complete the online form below or hard-copy form above. If appealing for more than one semester, a separate form is required for each semester.
A detailed personal statement is required for the appeal process describing your hardship circumstances to the committee. Space is provided for this statement within the online hardship withdrawal appeal form. Students submitting a hard-copy appeal must include a printed, thorough statement explaining the hardship circumstances experienced.
Supporting documentation verifying hardship circumstances must accompany every appeal. This documentation may be attached directly within the online appeal submission. Documentation and hard-copy appeals may also be dropped off in person at the Office of the Ombuds, sent by email, fax or standard U.S. mail. Our contact information is:
Office of the University Ombuds
1903 W. Michigan Ave.
Kalamazoo, MI 49008-5295 USA
ombuds@wmich.edu
Fax: (269) 387-0716
Results of the appeal will be sent to you via the email address you provide below. It is strongly suggested that students use their wmich.edu student email address if possible.

Contact Information

Name (required)

E-mail address (wmich.edu email address preferred) (required)

Phone

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Date of request (required)

WIN (required)

WMU Identification Number

Did you ever attend, participate or contribute to this course, even once? (required)

Yes

Have you consulted with Financial Aid/your funding source? (required)

Yes

N/A

Have you consulted with International Admissions and Services? (required)

Yes

N/A

Are you requesting full or partial withdrawal for this semester? (required)

Full

Partial

Semester you took the course in question (required)

Fall

Spring

Summer I session

Summer II session

Year you took the course in question (required)

Courses (required)

Re-order	Department	Course Number	Weight	Operations
	Department	Course Number	Item weight

more items

Detailed thorough typewritten statement indicating what happened, when it happened, how it affected you, and why you didn't withdraw before the end of the student initiated withdraw period. If you are doing a partial withdraw, please indicate why your hardship affected you in some but not all courses.

Supporting documentation certifying your circumstances must accompany your appeal. Documents may be sent to the Office of the Ombudsman by email, fax or standard mail. Please specify how you will be providing these documents. (required)

Drop off in person to the Office of the Ombudsman, 2420 Faunce Student Services Building.

Email to ombd_info@wmich.edu.

Fax to (269) 387-0716.

Send via standard mail to the Office of the Ombudsman, Western Michigan University, Kalamazoo MI 49008-5295 USA.

Upload your third party documentation electronically

By engaging in the appeal for a hardship withdrawal process, I give WMU and the Office of the Ombudsman permission to share submitted materials with a three-person Grade Appeal and Program Dismissal Appeals Committee panel for review. If approved, I give the Office of the Ombudsman permission to share the results with the Registrar’s Office. (required)

I agree

I disagree

Office of the University Ombuds
Western Michigan University

1903 W. Michigan Ave.
Kalamazoo MI 49008-5295 USA
Phone: (269) 387-0718
Fax: (269) 387-0716
Email: ombd_info@wmich.edu

Location
2420 Faunce Student Services Building, Mail Stop 5295