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Office of Learning Resources
Voluntary Medical Withdrawal
Request a medical withdrawal from the University
Request a medical withdrawal from the University
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Request a medical withdrawal from the University
Student Information
Are you submitting this request on behalf of a student?
No
Yes
Student found in person lookup above?
Student found in person lookup above?
Student found
Student not found. Enter student information manually.
Student first name
Student middle name
Student last name
Student personal/student email address
Phone number
When did you start at UD?
Provide the semester and year (eg; Fall 2020).
Classification
Undergraduate
Graduate
Law School
College of enrollment
College of Arts & Sciences
School of Business
School of Education and Health Sciences
School of Engineering
School of Law
Are you an international student?
No
Yes
What are your residency plans?
I plan to stay in the United States
I plan to return to my home country to recover
Withdrawal Information
Term of request
Use 2-letter and 4-digit for term (e.g. SP2022)
I understand that I need to meet with OLR Disability staff to discuss this request.
Note: If you select to not meet with OLR staff, a decision will be made based only on the information we have on file.
Yes, I will call to make an appointment
Yes, I have already scheduled an appointment
Yes, but I will not/did not schedule a meeting
I understand that I need to provide documentation from a licensed healthcare provider to support my request.
Note: If you choose to not provide documentation, a decision will be made based only on the information we have on file.
Yes, I have already submitted a statement from my healthcare provider
Yes, I have asked my healthcare provider to send a statement
Yes, but I will not provide documentation
Why are you requesting a medical withdraw?
Please describe the medical issue you are experiencing and how this is impacting your ability to address academic work (class attendance, studying, and testing) and residential experiences.
What have you and/or your healthcare provider been addressing to try to resolve your health issues? Please describe any provider recommendations, including when you first received these recommendations.
Remember, OLR must receive formal documentation from your treating provider before we can evaluate this request.
Please describe your attendance for each class from which you are requesting a withdrawal and include an estimated date of your last attendance.
Example:
Class 1: Astronomy 101, last attended on <Date>, <Reason>
I acknowledge that University Housing is for students attending classes. Identify where you are with respect to the housing process.
I am requesting a full medical withdrawal and understand I will have to move out of campus housing.
I am seeking a partial withdrawal and will have the 10 credits needed to remain in campus housing.
I would like to discuss housing options with fewer than 10 credits (Housing is not guaranteed)
I have already moved out of campus housing.
I do not live in campus housing.
Other Fields
Your name
Your first name
Your last name
Your email address