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Home
CS Late Withdraw Petition Form
CS Late Withdraw Petition Form
Student Information
8-Digit Spire ID#
*
First Name
*
Last Name
*
Local Address
*
Local Phone
*
###-###-####
UMASS Email Address
*
Confirm UMASS Email
*
Primary Major
*
- Select -
BS/BA Computer Science
BS Informatics
Exploratory Track in Computer Science
Secondary Major
Expected Graduation Date
*
(Month/Year)
Course History Information
For the course that you are requesting to withdraw, please provide the 3-digit catalog number, the full title, the semester & year, the schedule number, and the Instructor's name.
Course Title
*
e.g., CMPSCI 105
Full Course Title
*
e.g., Introduction to Programming
Semester and Year
*
e.g., Fall 2016
5-Digit Class Schedule Number
*
This is the 5-digit class number for the specific class or section you are requesting to withdraw.
5-Digit Lab Number
If necessary, include the 5-digit class number for the specific lab you are requesting to withdraw.
Instructor's Name
*
Justification
Reason For Request
*
Never attended (explain below)
Personal illness (explain below; requires verification from a physician)
Personal and/or family problems (explain below; requires verification, e.g. from a counselor, etc.)
Work schedule (explain below; requires verification of work schedule)
Other (explain below)
Briefly explain the reason for your request
*
I understand that this appeal will be reviewed by the Advising Committee and I will be notified of the decision by email. I understand that I must continue to attend the course(s) that I am requesting a late withdrawal(s) until I am notified that the late withdrawal(s) was approved. I understand that if verification is needed, that it is my responsibility to provide it to the committee.
Check here to indicate you have read and understand the above statements.
*
I understand