Temporary Withdrawal Request Form
If you have sought guidance from your academic department and have read the attached Guidance Notes and you are confident that Temporary Withdrawal is the correct course of action, then please complete this form and return to either your departmental office, yourDirector of Undergraduate/Graduate Studies or your personal tutor. You may wish to make a photocopy of this form before handing it in, for your records. The request will be considered by your department and if supported will be passed to the Academic Office for approval. If the request is approved, the Academic Office will confirm this to you in writing.
Sections 1, 2 and 4to be filled in by the student; Section 3 to be filled in by the Head of Department or Director of Undergraduate/Graduate StudiesPlease note that any information you provide will be treated in confidence and will only be seen by a small number of University staff who are either monitoring the provision of services or who are processing your request. You may wish to fill in Section 4 after yourHead of Department or Director of Undergraduate/Graduate Studies has filled in section 3.
Section 1.
Your details:
Surname:First name:
Student number:Date of birth:_____/_____/_____
Course:Course code:
Current year of study:Department:
Section2.
Please read carefully the Guidance Notes and Regulations below before filling inthis section.
Effective date of temporary withdrawal:___/___/___ Expected Return Date: ___/___/___
Reason for Temporary Withdrawal: please circle the reason/s for which you applying for temporary withdrawal:
a) Personal b) Medicalc) Maternity d) Other reason:
Please provide details on the above, you mayattach an extra sheet if you wish.
I declare that the above information is factually correct
Signature Date
Please return completed forms to Dr T E Bell (for undergraduate students) or Mr Rory McIntyre (for postgraduate students), Academic Office, University House, University of Warwick, Coventry CV4 8UW.
Section 3.
To be completed by the Head of Department or Director of Undergraduate/Graduate Studies
I support the above-named student’s request for a temporary withdrawal (please attach any additional information if appropriate).
Signature Date
Section 4
University Services
Have you had contact with any of the below people or services? If so, could you rate how helpful you felt their support was for you (please don’t rate services which you did not use):
Very helpful / Helpful / Unhelpful / Very unhelpful / I was unaware of this servicePersonal Tutor
Other departmental staff
Student Support
Careers Centre
Counselling Services
Senior Tutor’s office
Disability Services
Mental Health
Resident Tutor
International Office
Student Funding
SU Advice and Welfare
Chaplaincy
Health Centre
Please add further comments on the support you have been offered, including any support not listed above:
Please return completed forms to Dr T E Bell, (for undergraduate students) or Mr Rory McIntyre (for postgraduate students), Academic Office, University House, University of Warwick, Coventry CV4 7AL.
Guidance Notes
Please note: a student requestsa period of temporary withdrawal; the academic department decides whether they wish to support this request; the Academic Office thenapproves the request, i.e. a request must be supported by your department before it can be passed to the Academic Office for approval.
Effective date of temporary withdrawal and Expected Return Date
This may be retrospective, but you will need to discuss this with your department who will need to provide a rationale for this. It may be that the date is the first day of the Autumn, Spring or Summer Term. As temporary withdrawal is normally for a 12-month period for undergraduate students, return dates will correspond to the effective date of temporary withdrawal. NB in the first instance, the maximum period of temporary withdrawal which a student can request is 12 months (as stated in University Regulation 33). For certain postgraduate students, temporary withdrawal may be for less than 12 months, please contact the GraduateSchool for further advice on this.
Reason for Temporary Withdrawal
Please note that if you are requesting temporary withdrawal on medical grounds, you will need to provide certification from an appropriately qualified professional to support your need for withdrawal. You will also need to provide a satisfactorymedical note before your return to studies stating that you are now fit enough to resume studying. Please note that the medical note must come from a professional who knows your case or who has assessed your health very recently. Aletter will be sent to you 2 months before your return date to remind you about this.‘Other reason’ - for example this could apply to overseas students who are obliged to carry out military or civil service in their home country.
Library access
Students are not normally permitted access to the University Library whilst they are on temporary withdrawal. If exceptionally you require such access, your department must provide a statement in support of this request, which will be considered by either the Academic Registrar or Chair of the Board of Graduate Studies.
International Students
If you require student entry clearance or leave to remain (a‘visa’)to study in the UK,temporary withdrawal from your course is likely to affect your permission to remain here and it may be advisable for you to return to your home country. We strongly recommend that you seek confidential immigration advice from the International Office (024 7657 5229 or ). In order to comply with theUKimmigration regulations, the University is required to notify theimmigration authorities, where relevant, of changes to your enrolment status.
Don’t Forget
Before you go on temporary withdrawal remember to return any library books and return keys to Accommodation where necessary. You should also make sure that your personal tutor is aware of your situation.
Contact Details
If you change your address whilst on temporary withdrawal it is still your responsibility to change your details.
For the University ‘Regulations Governing Temporary Withdrawal from the University’ (University Regulation 33), please go to the below webpage of the Governance website:
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