Administrative Withdrawal Appeal Process

All students are required to both pay tuition and establish attendance through either submitting a Flex Course Check-In (FCC), or, any of the academic graded assessments within the first 8 days of the subscription period. Failure to pay or establish attendance by the specified deadline of 11:59 pm CST will result in the student being administratively withdrawn from course(s).

To appeal, the student must:

• Complete the Administrative Withdrawal Appeal Form below by 3:00PM on the first Friday following the administrative drop (11th day of subscription period).
• Provide supporting documentation which demonstrates the reason why the deadline was missed.
  • Acceptable reasons and documentation may include:
    • Family related:
      • Death of an immediate family member – provide obituary or funeral notice
    • Medical emergency:
      • Documentation of the medical emergency from a physician or emergency room, including the date of the emergency and an explanation of the situation.
    • Military Call-Up/Active Duty:
      • Provide copy of military orders, which include the start date of deployment
    • Technology issue:
      • Provide screenshot of the technology issue.
    • Other:
      • If you feel the situation falls outside of the reasons listed above, you may still submit an appeal. Please provide a detailed explanation and supporting documentation that impacted your ability to establish attendance or pay tuition.
• Submit the appeal and supporting documentation as described above by email to the Appeals Committee at
  registrar@uwex.wisconsin.edu.

Appeals will be reviewed by the committee, which meets as needed, and is comprised of representatives from the following offices: Registrar, Academic Success, and Financial Aid.

The committee will notify the student via campus email with their final decision within three (3) business days of receiving the appeal. The committee may request additional information from the student and/or Flex Faculty/staff in their review of the appeal. The decision of the committee is final.

If your appeal is denied, you may submit a term change form. Once the term change is processed, you can work with your Success Coach (SC) to re-enroll in the next available subscription period.

Company

This field is for validation purposes and should be left unchanged.

Name(Required)

Student ID Number(Required)

University Email Address(Required)

Phone

Success Coach Name

Degree Program Pursuing

Select Degree/Certificate ProgramAssociate of Arts & Science (Liberal Arts)Business Administration, Bachelor's DegreeBusiness Analytics CertificateDiagnostic Imaging, Bachelor's DegreeHealth Care InformaticsHealth SciencesInterprofessional Leadership in Healthcare MicrocredentialInformation Science & Technology, Bachelor's DegreeNursing (RN to BSN), Bachelor's DegreeAgile Project ManagementAgile Project Management Non-Credit CertificateSubstance Use Disorders Counselor

Select the Admistrative Withdrawal Type(Required)

Non Payment

FCC/Non-Attendance

Subscription Period Month(Required)

Select Subscription Period MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Subscription Period Year(Required)

Select Subscription Period Year2020202120222023202420252026

Reason for appealing

Family Related

Medical Emergency

Military Call-Up

Technology Issue

Other

Other Reason for appealing

Provide a detailed explanation of the request for the appeal.

Supporting documentation(Required)

Accepted file types: doc, docx, pdf, jpg, gif, png, Max. file size: 64 MB.

Supporting documentation verifying the reason for your appeal that coincides with the dates of your appeal is required. Appeals will be denied without documentation. Examples of acceptable documentation are: obituary/funeral notice for immediate family member, medical documentation provided by physician, emergency room, or hospital discharge papers, military orders, screen shots of technical difficulties, etc.

Consent(Required)

I understand and agree.

I understand the appeal decision will be communicated with me via campus email once the appeal committee has reached a
decision. If approved, I will be re-enrolled in the course(s) that were administratively withdrawn. I understand that if my re-
enrollment results in a balance, it is due immediately. If denied, I will need to complete the term change process for a future
subscription period. Falsifying information on this form will result in immediate denial and may be grounds for disciplinary action

Signature(Required)

Date(Required)

MM slash DD slash YYYY

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