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.

Retro Active Medical Withdrawal should be completed within 60 day of the semester of request. This timeframe can be extended in cases of extenuating circumstance, see Retro Active Medical Withdrawal Policy.

A student requesting a Medical Withdrawal (current semester) or Retroactive Medical Withdrawal (past semester) should complete the Student Request for Medical Withdrawal form (below) and submit it, along with accompanying documentation, by fax, email or time permitting by mail to the University Case Manager. The Licensed Provider Recommendation for Medical Withdrawal form should be faxed, emailed or with time permitting mailed by the provider to the University Case Manager. 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 Forms

Student Request for Medical Withdrawal

Licensed Provider Recommendation for Medical Withdrawal

Licensed Provider Recommendation for Return to Campus