Hardship Withdrawal Form

Hardship Withdrawal Form
Registrar Approval
Approver*

First NameLast Name
Student has withdrawn:*

Yes
Comments
I acknowledge that I have withdrawn myself from my courses prior to filling out this form*

YesNo
Please first withdraw yourself from your courses to continue on with this form.
According to WGTC's Policies and Procedures, "Students that withdraw after the designated deadline will receive a grade designation of 'WF'. A 'WF' grade is calculated into the students’ GPA as a failing grade. Due to significant hardship, it may be necessary for a student to withdraw from classes beyond the designated withdrawal date [consult the academic calendar for the current semester withdrawal date]." In those situations, students may apply for hardship withdrawal status through the Registrar's Office.

"Criteria for a Hardship Withdrawal may include, but is not limited to: hospitalization, medical emergency, family emergency, military duty, prolonged illness or other traumatic events. Requests must be submitted no later than the end of the subsequent semester and must include documentation for review. Decisions regarding the granting of hardship withdrawal is final and is not subject to appeal."

Students must withdraw through their Banner Web prior to submitting the Hardship Withdrawal Form. If you need assistance withdrawing, please email registrar@westgatech.edu.
Name*

First NameLast Name
WGTC Student ID Number*
WGTC Student Email Address*
username@student.westgatech.edu
Phone Number*
Please enter a valid phone number.
How many courses would you like to withdraw from?*
1. Course Name*
1. CRN*
Enter the CRN for this course. CRN must be between 20000 and 70000.
1. Instructor Name*
2. Course Name*
2. CRN*
Enter the CRN for this course. CRN must be between 20000 and 70000.
2. Instructor Name*
3. Course Name*
3. CRN*
Enter the CRN for this course. CRN must be between 20000 and 70000.
3. Instructor Name*
4. Course Name*
4. CRN*
Enter the CRN for this course. CRN must be between 20000 and 70000.
4. Instructor Name*
5. Course Name*
5. CRN*
Enter the CRN for this course. CRN must be between 20000 and 70000.
5. Instructor Name*
6. Course Name*
6. CRN*
Enter the CRN for this course. CRN must be between 20000 and 70000.
6. Instructor Name*
Name of class and CRN for which appeal is filed: one class per form. Students must complete a new form for each class. If you do not know the class name or the CRN, please refer to your student detail schedule in Banner Web or to your syllabus.
Name of the instructor: If you do not know the name of your instructor, please refer to your student detail schedule in Banner Web or to your syllabus.
Hardship withdrawals may be submitted after the withdrawal deadline for the semester [consult the academic calendar for the current semester withdrawal date]. Please include the semester you are requesting the hardship withdrawal for.*
Last date of attendance*

MonthDayYear
Date
Please provide the hardship situation that began after the semester began and which has impacted your ability to complete your course(s). List:

1. All pertinent dates related to the hardship
2. Details regarding the impact of the hardship on academic performance
3. Any communications made with course instructors regarding the hardship
4. Any student support sought during the semester
Please also attach any relevant documentation related to your circumstances.

Cancelof
What prevented you from withdrawing prior to the withdrawal date of the semester?*
All formal communication from the school will come to your student email address.*

I have read and understood.
Approval of a hardship withdrawal does NOT change/improve your financial aid status or tuition owed to the college.*

I have read and understood.