Get Wayne State Medical Withdrawal

This guide provides clear instructions for completing the Wayne State Medical Withdrawal form online. By following these steps, users can effectively navigate the process and ensure successful submission.

Follow the steps to accurately complete the medical withdrawal form.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editing tool.
2. Begin by completing Part I of the form, which requires you to enter your personal details. Fill in your last name, first name, middle name, WSU ID number, and contact information including your WSU Access ID and phone number. Ensure all information is accurate as all decisions will be communicated via your WSU email address.
3. Indicate the applicable term and year for which you are requesting a medical withdrawal. You will see options for Winter, Spring-Summer, and Fall. Please select the correct option.
4. Provide detailed information about your courses for the applicable term. For each course, enter the department, course number, CRN, number of credits, last attended date, and date of withdrawal (if appropriate). If you do not have this information, refer to your course schedule.
5. In the section for the reason for your request, clearly describe the circumstances leading to your withdrawal. Attach any additional pages if necessary to provide a thorough explanation.
6. Indicate whether you are a financial aid recipient by circling 'yes' or 'no.' If you circle 'yes,' be aware that you may need to repay financial aid for the academic year if your request is approved.
7. Sign and date the certification section of the form, indicating that you authorize any physician or hospital to release relevant information concerning your request and that the information provided is true and correct.
8. Once Part I is completed, forward the form to your physician for them to fill out Part II. Ensure they include all required medical details and their signature.
9. After completing Part I and obtaining the physician’s details in Part II, review the entire form to ensure accuracy and completeness before submission.
10. Save your changes and download, print, or share the completed form as necessary. You can then submit the form via mail, fax, or in person to the appropriate office indicated on the form.

Complete your medical withdrawal form online today to ensure timely processing.