EmailMe Form - Emergency Withdrawal Application

Please use this form to request a non-academic emergency withdrawal for the current or a previous semester.

The CARE Team will review only completed applications, including a personal statement and supporting documentation.

Be sure to review the Emergency Withdrawal website to be informed about the process and policies.

BACKGROUND INFORMATION

This section refers to the individual who is actually completing this request for an emergency withdrawal. This person may be the student or the appropriate family member acting on behalf of the student who is incapable of completing the form due to their medical condition.

Your full name: *

First MI Last

Student or family member? *

Your phone number: *

### - ### - ####

Your Email *

Semester of Emergency Withdrawal: *

Last Date of Attendance *

MM / DD / YYYY

Student's primary campus: *

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Please use this form to request a non-academic emergency withdrawal for the current or a previous semester. The CARE Team will review only completed applications, including a personal statement and supporting documentation.

BACKGROUND INFORMATION

Please use this form to request a non-academic emergency withdrawal for the current or a previous semester.

The CARE Team will review only completed applications, including a personal statement and supporting documentation.