This form may also be downloaded and filled out in paper form (Word document):
Appeal for Non-attendance Withdrawal form
Permission to withdraw from a course for non-attendance after the student-initiated withdrawal period has passed may be granted only for students who did not attend, participate or contribute to the courses in any way—even once—whether online, traditional lecture, or any other method or setting.
A statement from you verifying that you did not attend, participate or contribute to the courses in question must accompany your appeal for a non-attendance withdrawal. The statement may be included with this form; dropped off in person; or sent to the Office of the Ombudsman by email, fax or standard mail. Contact information is at the bottom of this form. When the non-attendance appeal form and statement are received, the Office of the Ombudsman will confirm non-attendance with the instructors of record for the courses. Your appeal cannot be reviewed until all information—completed appeal form and non-attendance statement—is received by the Office of the Ombudsman.
If you do not know the department or course numbers, simply write “All courses” in the boxes provided. International students are strongly urged to meet with International Admissions and Services for further direction. If you are a financial aid recipient and withdraw from some or all of your classes, the outcomes may include loss of future financial aid eligibility, reduced aid awarded for the semester, or required return of refunded aid. Communication with Student Financial Aid and Scholarships is strongly recommended.
There is no time limit as to how long a non-attendance withdrawal appeal will be accepted after the semester in question has ended; however, Accounting Services upholds a 12-month time limit on potential tuition charge refunds for non-attendance withdrawals. For more information regarding tuition charge refunds, please contact Accounting Services at (269) 387-4230 or firstname.lastname@example.org.
The decision to approve a non-attendance withdrawal is made by the Office of the Ombudsman on behalf of the Grade Appeal and Program Dismissal Appeals Committee based on information provided by the student and instructors of record. Appeals for non-attendance withdrawal will not be approved until non-attendance is confirmed for the entire appeal.
- Complete this form. If appealing for more than one semester, a separate form is required for each semester.
- Affirm or deny the non-attendance statement at the bottom of this form. If you wish to submit a paper form, be sure to include a signed statement explaining that you never attended, participated or contributed to the courses in question. Paper forms and statements may be dropped off in person or sent to the Office of the Ombudsman by email, fax or standard mail. Contact information is at the bottom of this form.
- Results of the appeal will be sent to you via the email address you provide below.