Withdrawal Petition Form - Access Request

This access request form will be sent directly to your major College Advising Center upon completion.

You must use this access request form to ask your College Advising Center to begin the Withdrawal Petition Form on your behalf.

PLEASE NOTE: Submitting this access request form is only the first step in a two-step process.

When your College Advising Center receives your request, they will review your details carefully and initiate a Withdrawal Petition Form on your behalf via Adobe Sign. Once initiated, you will receive a blank copy of the Withdrawal Petition Form in your Cal Poly email inbox.

YOU MUST open the Adobe Sign form, complete all required fields, and sign the document. Once you have signed, your Withdrawal Petition Form will continue to the next recipient for additional review and processing.

Student Name

Cal Poly Email

EMPL ID

Please choose the College that houses your Major

Major

Are you hoping to withdraw from a COURSE or from the TERM?

Please provide as much detail as possible for your College Advising Center. If your College Advising Center deems it appropriate to initiate a Withdrawal Petition Form on your behalf, you will have the opportunity to explain the circumstances surrounding your withdrawal (to your comfort level) on the form itself.

Which term do you want to withdraw from? (Ex: Summer 2026, Fall 2026, etc.)

Last date of attendance for this term (MM/DD)

Please list every course you are currently enrolled in (including the section) with the corresponding instructor name and their Cal Poly email:

DeleteAdd course _ID_
Course Withdrawal Class Replicate Block
Course Name Course Number and Section (Ex: ENGL 134-01) Term in which you are enrolled in this course (Ex: Fall 2026, Spring 2026, etc.) Name of Instructor Cal Poly email of Instructor

Add course

Please explain why you need access to this form