Administrative Withdrawal Due to Class Disruption Form

For academic department use only

This form is used by the instructor to request an administrative withdrawal of a student due to class disruption.

Do not return this form to the Office of the Registrar. The original copy must be submitted to the Associate Provost for Faculty and Academic Affairs. A copy of the completed form should be kept in the department office.

Download Administrative Withdrawal Due to Class Disruption form (fillable PDF)

Download Administrative Withdrawal Due to Class Disruption form (Word version)

University policy

The course instructor has original jurisdiction over his/her class and may deny a student who is unduly disruptive the right to attend the class. The student is expected to comply with all reasonable directives of the course instructor. The course instructor may have a student administratively withdrawn from a course upon showing of good cause and with the concurrence of the department head. The appeals process in case of such administrative withdrawal shall be as stated in the Grade Appeals and Academic Grievances policy.

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