Undergraduate Request to Return: Form

Petition to Return Following Withdrawal

This form will take 15 to 30 minutes to complete. There are multiple open-ended questions presented and students are asked to answer thoroughly and honestly.

Incomplete forms will not be reviewed or considered. Submissions received after the start of the term will not be considered, per policy. If you have questions or concerns, please contact Colin Terry, Assistant Vice President for Student Life, at cterry@mines.edu.

This form is due before the first day of the upcoming Term. For Spring 2024, this form must be submitted by January 8th, 2024 by Noon (MT).

You are encouraged to save your work/answers as you progress through the form.

Last name: *

First name *

Campus Wide ID Number (CWID): *

Mines E-mail address: *

Alternative, Personal E-mail Address: *

What your best contact number (e.g. Cell?): *

Today's date: * +

Save & Return

Save your progress and complete this form later (optional)