Medical Withdrawal

Request for a medical withdrawal (serious physical and/or psychological illness of the student) is voluntary and limited to students who have not taken a final exam or otherwise completed coursework for a final grade.

A student requesting medical withdrawal based on medical circumstances should complete the Student Request for Medical Withdrawal form (below) and submit it, along with accompanying documentation, by fax or time permitting by mail to the University Case Manager. The Licensed Provider Recommendation for Medical Withdrawal form should be faxed or with time permitting mailed by the provider. The student will be expected to sign a release to the provider so documentation can be verified by the University Case Manager. Failure to do so will result in denial of request.

Fax: 256-765-4235
Mail: 1 Harrison Plaza; UNA Box 5023; Florence, AL 35632

Medical Withdrawal Policy

Medical Withdrawal Forms

Student Request for Medical Withdrawal

Licensed Provider Recommendation for Medical Withdrawal

Licensed Provider Recommendation for Return to Campus