Retroactive Withdrawal Request

This form is for former NC State students, who no longer have active campus (MyPack) credentials, who need to request a retroactive term withdrawal from NC State.

If you are a current NC State student, with active MyPack credentials, log into your MyPack Portal to submit the Term Withdraw form under Planning & Enrollment.

If you are requesting a retroactive withdrawal for more than one term, submit a separate request for each term.

Acknowledgement

By submitting this form you must acknowledge the following.

Consult with your advisor/department before initiating a withdrawal for a previous term to discuss the academic implications of your request. *

I acknowledge

Athletes and international student requests will be reviewed by appropriate offices prior to approval and additional information may be required. *

I acknowledge

A withdrawal may impact your academic eligibility, financial aid, and progress toward a degree. *

I acknowledge

Approved retroactive withdrawals are effective the last day of the term and do not provide any refunds for tuition and fees. *

I acknowledge

Requests for retroactive term withdrawals are approved by the university only under extenuating circumstances. The presence of extenuating circumstances does not guarantee the approval of a request. Requests are approved by an undergraduate’s college or by a graduate’s DGP and The Graduate School on a case-by-case basis. *

I acknowledge

Documentation to support the extenuating circumstances is required and is valuable to those who review your request. *

I acknowledge

Your Current Information

First Name *

Middle Name

Last Name *

Suffix

Date of Birth *

Email Address *

Phone Number

Previous NC State Information

This information is used to identify your record in our system so please provide what is applicable or you remember.

Previous Last Name (if applicable)
Your last name when last enrolled at NC State if different from above.

NC State Student ID Number, if you remember it (do not guess)

NC State Unity ID, portion of your NC State Email Address before the @ symbol

What was your last term of attendance at NC State? (i.e. Spring 2002)

Identity Verification

A LEGAL DOCUMENT MUST BE PRESENTED TO CONFIRM YOUR IDENTITY. *

Select which document you will be uploading.

Driver's License or State Issued ID Card

Certified Copy of Court Order granting name change

Marriage Certificate or Divorce Papers (NOTE: must reflect the official name change)

Please upload the appropriate material listed above. *

Person Status (Hidden) of Former Student

Withdrawal Questions

Which term are you requesting a retroactive withdrawal from (i.e. Fall 2024) *

Requests for a retroactive withdrawal must include reasonable supporting documentation which demonstrates serious extenuating circumstances to receive approval. Examples of serious extenuating circumstances may include, but are not limited to, medical reasons (physical and/or mental health), personal/family emergency, personal hardship, or military service.

Provide a reason and brief explanation for your request *

Requests for hardships require verification that a documented unforeseeable hardship of any kind resulted in it being unreasonable for the student to continue in the given term. Examples include documentation of a work transfer out of the Triangle area, a copy of an insurance claim confirming the destruction of primary residency due to fire, an obituary, etc.

Requests for medical reasons require certification by an appropriate medical professional of a serious disruption in academic functioning for medical reasons. Such medical petitions are subject to review by a University physician. A letter of explanation template and guidance for your service provider is available here.

Requests for military reasons require verification that the student has been called to active duty or training in the United States Armed Forces. This can include service in the National Guard or Reserve. You should upload a copy of your activation orders in the Upload Documentation section.

Requests for psychological reasons require certification by the Counseling Center or by an independent licensed mental health professional of inability to continue for psychiatric / psychological reasons. The latter are subject to review by the University’s Counseling Center. A letter of explanation template and guidance for your service provider is available here.

Explanation *

Supporting Documentation

Documentation supporting your extenuating circumstances is required. Be sure to redact sensitive information (social security number, medical record number, etc.).

Document Upload Disclaimer: Consistent with the Family Educational Rights and Privacy Act (FERPA), documents may be shared with University officials with a legitimate educational interest. Submission of documentation provides authorization for a University physician or mental health professional to discuss and provide an opinion of the documentation to other University officials. If your supporting documentation is of a medical or psychological nature and you are not comfortable sharing that information with non-medical university staff, please visit the following page for information https://counseling.dasa.ncsu.edu/services/academic-counseling/. Details will be held confidential but a general summary to substantiate the request will be communicated to university staff with authority to approve withdrawal requests.