Administrative "W" Form

Please submit one form for up to five courses
needing an administrative withdrawal.

This is an appeal request for an Administrative “W” and does not guarantee the appeal will be granted; this is purely a request for the college dean to review. Also, this form is used to seek an Administrative “W” for all classes taken the entire semester per the university policy. 

Please provide your reasoning for this request. Include what steps have been taken to resolve the issue, provide proper justification, and attach any documents you might have to be verified.

  • be able to demonstrate that the extenuating circumstance beyond your control were the cause of your grades,
  • provide documentation or proof of these circumstances,
  • provide documentation that these circumstances have been resolved,
  • and show evidence of the ability to successfully complete course work at Texas State.

After review for completeness of this form, you will be contacted to set an appointment with the associate dean of the college. From there, a decision will be made regarding your request.

First name, last name
Starts with the letter "A" and followed by 8 numbers.
Major *
Classification *
If your response to this question is "Freshman", refer to the note at the top of the page.
Example: MKT 3343
Example: 067
Example: Spring 2022
Do you have a second course needing an Administrative "W"?
Example: MKT 3433
Example: 067
Example: Spring 2022
Do you have a third course needing an Administrative "W"?
Example: MKT 3433
Example: 067
Example: Spring 2022
Do you have a fourth course needing an Administrative "W"?
Example: MKT 3433
Example: 067
Example: Spring 2022
Do you have a fifth course needing an Administrative "W"?
Example: MKT 3433
Example: 067
Example: Spring 2022
Documentation for a medical / similar emergency preventing completion of the course is required.
Type in your name to indicate an electronic signature.

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