Extenuating Circumstance

Extenuating Circumstance Request Form

Requests to withdraw due to extenuating circumstances require the below form to be filled out with the supporting documentation attached.

Exceptional Circumstances Typically Considered
•Serious medical situations
•Death of a participant, spouse, or immediate family member
•Life threatening illness to participant, spouse, or immediate family member

Please note that exceptions are granted at the discretion of the Lifelong Learning Program. The submission of this form does not guarantee a withdrawal and/or refund from your lecture series.

Name(Required)

First Last

Email(Required)

Phone(Required)

Which LLeaP series are you requesting a withdrawal from?(Required)

Please attach any supporting documentation below

Drop files here or

Accepted file types: jpg, png, pdf, doc, Max. file size: 15 MB.

E.g. medical certificate, doctor’s note, post-surgery instructions, etc.

Additional Context(Required)

Please provide any context surrounding your request to assist in the decision making process.

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