UGS 5thweek Retro
UGS 5thweek Retro
Late and Retroactive Change in Academic Schedule
for Undergraduate and Second Bachelor’s Students
Download, save and complete this form to request a change in schedule only after the Late Registration and Schedule
Adjustment deadlines for the current academic term. You may also request a retroactive change for a prior term with this form.
For this semester’s deadlines, see www.csun.edu/current-students/register/late-register/change-deadlines.
About Withdrawals:
Withdrawals are not permitted during the final 3 weeks (Last 20%) of instruction or thereafter except in cases such as an accident or
serious illness where the cause of the withdrawal is clearly beyond the student’s control and the assignment of an Incomplete grade
is not practical. Withdrawals will not be granted if the student has taken final exams or if they are found, at any time, to have
committed academic dishonesty in the class(es). Petitions requesting retroactive withdrawals beyond 1 year of the conclusion of the
semester or term for which the withdrawal is requested will not be considered.
Instructions:
1. Include a STATEMENT that describes the serious and compelling reason for your request and the consequences to you if
your request is not granted.
2. Please submit DOCUMENTATION, if available, supporting your clear and compelling reason for dropping your courses.
3. Medical requests must include DOCUMENTATION and a signed Student Consent and Health Care Provider Guidelines
form, available at www.csun.edu/sites/default/files/UGS_pmw_healthprovider.pdf.
4. To add one or more classes after Week 12 of the current fall of spring term, retroactively for a prior term, or after the published
deadline to add in summer or winter terms, request an EMAIL of approval from your instructor, the department chair, or the
associate dean of the college offering the course, and attach the approval to this form.
5. Email form(s), documents, and approvals (if adding) to the Office of Undergraduate Studies at ugs@csun.edu from your CSUN
email account or deliver in person to Valera Hall (VH) Room 215. Helpful: How to File a Form
Personal Data: PRINT or TYPE CLEARLY (form will not be accepted if illegible)
First and Last Name: CSUN Student ID:
Term (check one): Sp Su Fa Wi Year: Major:
Phone: CSUN email: @my.csun.edu Other email:
Nature of Your Request – Select one option only:
Add/Drop Class(es) Change Grading Basis Complete Medical Withdrawal Partial Medical Withdrawal
Requested Changes:
Add Add Change Department and 5-Digit Class Last Date of Attendance
Drop
(Grade) (CR/NC) Grade Basis Course Number Number during term (mm/dd/yy):
I have reviewed the Precautions for Reducing Units and Impact of Academic Schedule Changes for the possible effects on my Financial
Aid, Campus Housing, international student status, and more. If my request to add one or more classes is approved, I will check my
account balance in myNorthridge Portal for additional fees and payment deadlines if any. I understand the consequences of my
request and that the change will not be reversed once it is processed.
Student Signature Date
Approved: Denied:
Associate Vice President of Undergraduate Studies Signature Date
2/14/2022 UGS
