Maximum Repeat or Course Withdrawal Appeal Form

Student Name Required

NUID: Required

E-mail Required

Phone Required

Campus Required

Major Required

Reason(s) for appealing Required

Repeating an engineering course more than once

Repeating an engineering course after repeating three other engineering courses

Repeating a course after withdrawing from four other engineering courses

Withdrawing from an engineering course more than once

Select all that apply

The appeal is to request enrollment in the following course(s): Required

How many times have you previously repeated this course? Required

How many times have you previously repeated an engineering course? Required

How many times have you previously withdrawn from an engineering course? Required

Please attach the following documents:

Personal statement Required

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Files must be less than 5 MB.
Allowed file types: pdf doc docx.

Supporting document #1 (Optional)

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Files must be less than 10 MB.
Allowed file types: pdf doc docx ppt pptx zip.

Supporting document #2 (Optional)

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Files must be less than 10 MB.
Allowed file types: pdf doc docx ppt pptx zip.

Supporting document #3 (Optional)

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Files must be less than 10 MB.
Allowed file types: pdf doc docx ppt pptx zip.

I certify with my electronic signature that I will complete this course without further withdrawals or repeats if my appeal is granted

Signature Required

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