UNIVERSITY OF SOUTHERN MAINE
Leave this form with your instructor, who will grade you and forward the form to the
Registrar's Office
Date:___________________________
NAME:___________________________________________ STUDENT MAINESTREET ID _______________
Last
first
mi
CHECK ONE: FALL____ SPRING _____ SUMMER ______ YEAR________
_______
________ ______ _______________________
_______________________________
Dept
Number CRN Title
Instructor
example:
BIO
203 1234 DEVELOP
BIOLOGY
DOE
Dept
Number CRN
Title
Instructor
________________________________________________________________________________________________________
INSTRUCTOR’S NOTE:
When a student withdraws after the first eight weeks of a semester, the student will receive a grade
designation to be determined by the instructor. One of the regular grades, normally F, will be assigned during
this period. WP and WF grades are not valid and the grade of W is to be assigned only under unusual
circumstances as determined by the instructor and the Dean. Please complete the information requested
below and mail or deliver this document to the Registrar’s Office on either campus.
* If the W is designated, the signature of the Dean of the School or College is Required.
** If a passing grade is assigned, the student will receive credit for the course and the grade will be included
in the calculation of the student’s G.P.A.
FINAL SEMESTER GRADE ASSIGNED: (Circle one or
fill in the grade) F, W, or I **_______
Instructor's Signature _____________________________________Date____________
_______________
______________________________________________________
Withdrawal Date Deans Signature (W
grade only)
Remarks:____________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________