Appeal for a Hardship Withdrawal

Office of the University Ombuds

This form may also be downloaded and filled out in paper form (Word document):

Permission to withdraw from a �� Michigan University course after the student-initiated withdrawal period has passed may be granted only for hardship circumstances beyond your control that limited your ability to perform normally in the course. Hardship may include, but is not limited to: severe physical or mental illness, injury of student or close family member, death of a close family member, act of violence, and exigencies of military service where established procedures are not applicable. Examples of situations not considered a hardship include, but are not limited to: student dislikes course, teaching method or professor; student considers course too difficult; student has taken on more academic or other obligations than student can handle; change in major so course no longer needed; financial constraints; any situations of resolved or unresolved academic integrity charges.

A statement from you and documentation verifying the extenuating circumstances must accompany your appeal for a hardship withdrawal. When the appeal form, statement and documentation are received, a Hardship Assessment Panel will review your case and render a decision. Your appeal cannot be reviewed until all information—appeal form, typewritten statement and documentation—is received by the Office of the Ombuds. 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.

Except for documented and exceptional circumstances, hardship appeals will not be accepted more than one year after the end of the term or session for which the hardship was documented. All petitions filed after the one-year timeline must be granted an exception by the Office of the Provost prior to consideration by the Hardship Assessment Panel. The Office of the Ombuds will facilitate the exception process.

The decision to grant a hardship withdrawal is made by the Grade Appeal and Program Dismissal Appeals Committee. Appeals are reviewed in the order received and results may take six to eight weeks. All decisions of the committee are final and not subject to appeal.

Instructions

Complete this form. If appealing for more than one semester, a separate form is required for each semester.
Type a detailed, thorough statement explaining the circumstances you experienced. The statement may be included with this form; dropped off in person; or sent to the Office of the Ombuds by email, fax or standard mail. Contact information is at the bottom of this form.
Supporting documentation certifying your circumstances must accompany your appeal. Documents may be dropped off in person or sent to the Office of the Ombuds 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.

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)

�� 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, �� Michigan University, Kalamazoo MI 49008-5295 USA.

Upload your third party documentation electronically

Please include any necessary attachments

One file only.
8 MB limit.
Allowed types: gif, jpg, jpeg, png, txt, doc, docx.

By engaging in the appeal for a hardship withdrawal process, I give �� 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
�� 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

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Office of the University Ombuds

Appeal for a Hardship Withdrawal

Instructions

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