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PETITION FOR COURSE DROP
Distance Education Students Only

Students attending classes on campus must pick up a drop slip at the Registrar's Office and follow the procedures on the form.

Any student who is dropping ALL courses for a term, must process a WITHDRAWAL through the Dean of Student's Office. This may be done by calling (940) 397-6273. (You should NOT complete this form if you are dropping ALL of your classes for the term.)

If you are a distance education student who wants to drop a course (but still be enrolled in at least one other for the same term), please complete the following form and click submit. This will notify the Office of the Registrar by e-mail. You will be dropped from your course and we will notify your instructor and advisor. Please complete a separate form for each course you want to drop.

Refunds and grades for drops will be made in accordance with the deadlines set out in the semester Schedule of Classes. A course for which a drop is received after the published "Last day to drop with a 'W'" deadline will be given a grade of "F."

Drop Deadline:
Summer I 2013 (regular term): June 19, 2013
Summer I 2013 (LONG summer term): July 11, 2013
Summer II 2013 (regular term): July 24, 2013

NOTE: If you are on Financial Aid, please check with that office before dropping to see how it could affect you (940-397-4214).

1.	Semester in which course is to be dropped:

2.	Full Legal Name:*

3.	MSU Mustangs ID Number or Social Security Number:*

4.	Phone Number: include area code (no dashes or special characters)

5.	E-Mail Address: if we have questions about this drop

6.	Course Prefix and Number (example: POLS 1333-X30):* REMEMBER, if this is your only course, or if you are attempting to drop all courses, you must contact the Dean of Students Office to Withdraw! Completing this form will NOT drop you from all courses.

7.	Course Title:*

8.	Day / Time class meets (example: Wednesday 7-9pm)

Program or site where course is offered:*

	Internet Only
	Nursing Distance Program
	Radiologic Sciences Distance Program
	Respiratory Care Distance Program

Other, please specify

10.	Instructor's Name:

11.	Advisor's Name:

12.

Please indicate which of the reasons below pertains to this drop:*
Select at least 1 and no more than 1.

	Severe illness or debilitating condition preventing completion of course.
	Responsible for caring for a sick, injured, or needy person.
	Death of close family member.
	Active duty service in U.S. Armed Forces or National Guard or that of an immediate family member.
	Change in student's work schedule beyond control of student.

Other, please specify

13.

Please check indicating your permission for us to drop the above course. Any refund will be in accordance with the policies and dates set forth by the MSU Business Office in the Schedule of Classes.*

I agree