Petition for Late Withdrawal

This form is used by students seeking to withdraw from individual courses past the withdrawal deadline posted on the Academic Calendar. Students using financial assistance (military benefits, financial aid, scholarships, etc.) should contact the appropriate office to discuss the impact before submitting this form for review.

Name(Required)

First Middle Last

Student Email(Required)

TCC Student ID#(Required)

Class No.(Required)

Subject(Required)

Catalog No.(Required)

Class Section(Required)

Semester/Term(Required)

Year(Required)

Last Date of Attendance(Required)

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Year (old)

Please enter a number from 2020 to 2040.

Instructor's Email(Required)

Reason for Withdrawal(Required)

Explain your reason in detail(Required)

Please attach supporting documentation/information as necessary/helpful.

Drop files here or

Accepted file types: pdf, txt, doc, docx, rtf, Max. file size: 32 MB.

Signature(Required)

INSTRUCTOR: Please review the student’s submission and decide whether to approve or deny it. If you approve, select the appropriate Pathway Dean to forward the request for final approval. If you deny, provide the reason for the denial, which will be communicated back to the student.

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Instructor Approval(Required)

Approved

Denied

Indicate whether you approve or deny this request.

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Instructor: Please attach supporting documentation/information as necessary/helpful.

Drop files here or

Accepted file types: pdf, txt, doc, docx, rtf, Max. file size: 32 MB.

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Which Academic Dean should receive this for approval?(Required)

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Dean Email

Holds the selected dean’s email address for workflow use.

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Instructor Denial Reason(Required)

Please provide your reason for denying this request. This reason will be communicated back to the student.

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Instructor Signature(Required)

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Instructor Date(Required)

DEAN: Please review this student’s submission and either approve or deny the request. The instructor has already approved the request. If you approve it, it will be sent to enrollment@tcc.edu for processing. If you deny it, please provide your reason for the denial and it will be communicated back to the instructor and student. If this form is submitted after the end of the course’s semester, it must be forwarded to the VP for Academic Affairs or their designee for approval.

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Dean Approval(Required)

Approved

Denied

Indicate whether you approve or deny this request.

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Dean Denial Reason(Required)

Please provide your reason for denying this request. This reason will be communicated back to the instructor and student.

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Dean Signature(Required)

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Dean Date(Required)