Students with extenuating, documented circumstances may be eligible for an administrative withdrawal. This form can be used for administrative withdrawal requests for classes that are currently in progress, but for which the withdrawal deadline has passed.

If you are seeking an administrative withdrawal for a course in a semester that has already ended, please use the Administrative Withdrawal: Past Semester form.   

Extenuating circumstances should meet one of the following criteria:

  1. Those that interfere with a student’s ability to attend class- resulting in an inordinate number of absences, or
  2. Prevent a student from withdrawing from the class before the withdrawal deadline

Extenuating circumstances should be supported with appropriate documentation, and should follow these guidelines:

  • Documentation should be signed, dated, and on organization (employer, doctor, court, etc) letterhead
  • Can include (but are not limited to):
    • Court documents
    • Medical documents
    • Signed and dated letter from employer
    • Signed and dated letter from doctor
    • Document issued by a third-party, such as school, hospital, company, etc

Documents that are handwritten and from friend, coworker, neighbor, etc are not accepted as support for an administrative withdrawal. Documents provided must align with the dates and extenuating circumstances stated in this form.

By completing and submitting the form below, you are stating that you wish to be considered for an administrative withdrawal, per LCCC’s Administrative Withdrawal Policy.

  • Your request will be reviewed and considered based on extenuating circumstances described in your request
  • Documentation to support the extenuating circumstances is requested
  • If you need more space than this form provides, please complete your explanation in a Word document and attach using the additional documentation box provided below

Watch your LCCC email account for results of your appeal and requests for additional information as needed.

PLEASE NOTE: A separate submission is needed for each individual course for which a student wishes to be withdrawn, as requests are reviewed by the dean in the division housing the course.

 

Please complete and submit the form below:

 

  • Name * Required
  • Academic Division

    Please identify the Academic Division that houses the course from which you wish to be administratively withdrawn. The following list will help you determine which division offers your course.

    Health and Wellness
    For courses that contain ALHN, EMSB, FIRE, HLED, HPED, PEDF, PEFT, PESP, or PEWL.

    Arts and Humanities
    For courses that contain ARTS, CHNS, CMMC, CULN, DANC, ENGL, ESLG, GRMN, HUMS, JRNM, MUSA, MUSC, PHLY, RDST, RELG, RSCH, SPNH, TCMN, or THTR.

    Engineering, Business and Information Technologies
    For courses that contain ACTG, AETC, ALET, AVIA, BADM, BANK, CADD, CAMM, CGSD, CISS, CMNW, CMPR, CNST, CYBER, DATA, DFAB, ELCT, EMCH, ENGR, ENTR, FNCE, IIOT, MEMS, MKRG, QLTY, SAFE, TECN, TRSM or WTEC.

    Science and Math
    For courses that contain ASTY, BIOG, CHMY, CMPR, MTHM, PHYC, PSSC, or SAGR.

    Social Sciences
    For courses that contain ARCH, CRMJ, ECED, ECNM, EDCT, GPHY, HMSR, HSTR, PBAD, PLSC, PSYH, SOCY, SOWK, URBS, or WMST.

    SDEV and Other Courses
    For courses that contain SDEV.

    Select the appropriate Academic Division from the dropdown box below.

    Please Note: You must complete a separate request form for each course from which you wish to be academically withdrawn.

  • Academic Division * Required
  • Please provide documentation.

    Please upload documentation to support this request.
  • Accepted file types: doc, pdf, jpg, png.
    Allowed file extensions - doc pdf jpg png.
  • Accepted file types: doc, pdf, jpg, png.
    Allowed file extensions - doc pdf jpg png.
  • Accepted file types: doc, pdf, jpg, png.
    Allowed file extensions - doc pdf jpg png.