Liberal Arts Administrative Withdrawal Petition Form

Please provide the information requested below if you are seeking Administrative Withdrawal from the Dean of the College of Liberal Arts.

First Name *

Last Name *

Texas State ID (A0...) *

Email Address *

Phone Number *

Mailing Address (include city, state, and zip) *

Major *

For each course petition include: course name, number, section, instructor, department, semester, year, and last date attended. *

In the space provided below, please provide your letter appeal, which should explain the extremely extenuating circumstances that occurred in the semester(s) for which you are seeking Administrative Withdrawal. *

You may also upload your letter of appeal. *

I understand that I must submit documentation to have my Administrative Withdrawal petition reviewed. *

Yes

Sensitive Documents

Please submit sensitive documentation such as medical information, information that contains Social Security numbers or other personally identifying, etc., using Texas State's secure file transfer system. When you log into the system to send your secure email, use j_v311@txstate.edu as the address to which you send your documents.

Attach supporting documentation: *

Supporting documentation should be from the semester(s) in which you had academic difficulty. Examples of supporting documentation are:

hospital bill
obituary
divorce decree
medical diagnosis
disability diagnosis
work record
police report
court records

Financial Aid Consequences

Withdrawing from courses can have serious consequences for students receiving financial aid. In some cases, financial aid funds may have to be repaid. You are strongly encouraged to seek advice from the Office of Financial Aid & Scholarships and an Academic Advisor to learn the consequences you may face if granted Administrative W's.

I understand there may be financial aid consequences for Administrative W's and that I should investigate this with the Office of Financial Aid & Scholarships. *

Yes

If you happen to see this, do not fill this field.