Statement of Mitigating Circumstances for COVID-19

Name(Required)

First Last

Student ID (T00######)(Required)

Email Address(Required)

I am withdrawing from one or more classes under the following circumstance(s): Please select the most applicable reason(Required)

Complications due to COVID-19

An illness or injury during the enrollment period.

An illness or death in my immediate family.

An unavoidable change in my conditions of employment.

An unavoidable geographical transfer resulting from my employment.

Immediate family or financial obligations beyond my control that requires me to suspend pursuit of my program of education to obtain employment.

Discontinuance of the course by the school.

Unanticipated active military service, including active duty for training.

Unanticipated difficulties with childcare arrangements I made for the period during which I am attending classes.

Please select only one option for documentation.(Required)

In the interest of protecting my privacy, I request that UA Little Rock Military Student Success not keep documentation concerning my mitigating circumstance(s). I am prepared to provide the VA proof of my mitigating circumstance(s) upon request.

I am providing proof of my mitigating circumstances and request that UA Little Rock Military Student Success retain a copy in my records. I am, however, prepared to provide the VA proof of my mitigating circumstance(s) upon request.

Attach any supporting documents.

Drop files here or

Max. file size: 49 MB.

I further understand that debt mitigation is entirely at the discretion of the VA and may not be approved. Please initial.(Required)

Statement of Mitigating Circumstances for COVID-19

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