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Wellbeing Services

Medical/Mental Health Withdrawal

Medical Withdrawal from the University

Our role is to collect, review, and verify the documentation that you submit supporting your request for a Medical or Mental Health Withdrawal. 世界杯官方app Wellbeing Services will maintain the privacy of your documents throughout this review process. 世界杯官方app Wellbeing Services will submit a recommendation to the M/MH Committee after all the documentation has been received and verified. The M/MH Committee will make the final decision regarding each student’s Medical or Mental Health Withdrawal request.

Medical/Mental Health Withdrawal Policy

  • Medical/Mental Health Withdrawal Application


    Complete the Medical/Mental Health Withdrawal Request form and then submit it to Student Assistance Services.

    Download the Entire Application

 

Use the links below to view each section of the Medical/Mental Health Withdrawal Application separately. 

  • Medical/Mental Health Withdrawal Request Guide and Checklist

    This Guide for Students is the cover letter, explaining the reasoning behind all of the Medical/Mental Health Withdrawal Documents. The checklist    helps ensure you have everything you need for a Medical/Mental Health Withdrawal.

  • Authorization To Release Records and Information For Medical/Mental Health Withdrawal Request

    These Authorization To Release Records and Information For Medical/Mental Health Withdrawal Request    allows 世界杯官方app Wellbeing Services permission to act on your behalf with the necessary 世界杯官方app Departments and to contact your medical provider for the purpose of your Medical/Mental Health Withdrawal.

  • Informed Consent: Medical/Mental Health Withdrawal Requests

    The Informed Consent: Medical/Mental Health Withdrawal Requests    provide explanations of confidentiality, maintenance of records, services offered, and emergency/after-hours resources.

  • Personal Statement

    The Personal Statement    provides instructions on writing your personal statement regarding why you're requesting a Medical/Mental Health Withdrawal.

  • Medical Provider Statement

    The Medical Provider Statement    has instructions for your medical provider on how to provide a statement describing why you need a Medical/Mental Health Withdrawal.

  • Transcript

    A current transcript (i.e. can be an unofficial copy) with the final grades earned during the semester in which you are applying for the Medical or Mental Health Withdrawal. Transcripts can be requested by accessing the Registrar’s Office online  .