Appeal for a Non-attendance 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 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, Accounts Receivable upholds a 12-month time limit on potential tuition charge refunds for non-attendance withdrawals. For more information regarding tuition charge refunds, please contact Accounts Receivable at (269) 387-4141 or acnr-tuitionappeals@wmich.edu.

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.

Instructions

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.

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

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

I certify that I have not attended, participated or contributed to the courses in question for this appeal. (required)

Affirm

Deny

By engaging in the non-attendance withdrawal appeal process, I give �� and the Office of the Ombudsman permission to share submitted materials with the instructors of records and academic departments in question for the courses listed above. 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 Ombudsman
�� Michigan University

1903 W.Michigan Ave.
Kalamazoo MI 49008-5295 USA
Phone: (269) 387-0718
Fax: (269) 387-0716
Email: @email

Location
2420 Faunce Student Services Building, Mail Stop 5295

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Office of the University Ombuds

Appeal for a Non-attendance Withdrawal

Instructions

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