Withdrawal Request Form

Dean of Students Withdrawal Request Form

This form is intended for complete withdrawals during the current semester, or for retroactive withdrawals from previous semesters. 

I understand that the following are not acceptable stand-alone reasons for requesting a withdrawal: 1. Poor performance in class 2. GPA protection 3. Failure to verify class schedule through myUCCS portal 4. Failure to monitor waitlist position 5. Change of major or program that results in a course no longer being a requirement  

UCCS has a responsibility to provide a safe and nondiscriminatory environment. If you disclose having been impacted by sexual misconduct, protected-class discrimination or harassment, intimate partner violence, stalking, or related retaliation, we are required to share that information to the UCCS Office of Institutional Equity (OIE) for outreach regarding support and reporting options. You are not required to respond to OIE. Additionally, please note that the university takes disclosures around threat of harm to self or others seriously and when information of this nature is received, it will be shared with the appropriate offices to offer additional support and resources. 

I certify that the information given is correct. I understand that providing false statements or false documentation is a violation of the Student Code of Conduct and that any violations will be reported to the Office of the Dean of Students. 

Supporting Documentation