Get Medical Reduced Course Load Provider Form - University Of Utah ...

The Medical Reduced Course Load Provider Form is essential for students at the University of Utah seeking approval for a reduced course load due to temporary medical conditions. This guide will assist you in filling out the form accurately and efficiently online.

Follow the steps to successfully complete the Medical Reduced Course Load Provider Form.

1. Press the ‘Get Form’ button to download the Medical Reduced Course Load Provider Form. Ensure to open it in an appropriate editor for filling out.
2. Begin with entering the student's first and last name in the designated fields. This information should be clear and accurate, as it identifies the individual requesting the reduced course load.
3. As a licensed medical provider, you must initial in each box that applies to confirm your credentials, assess the student’s medical situation, and recommend the student for a reduced course load.
4. Provide a brief description of the medical reason for recommending a reduced course load. Ensure precision in this section to outline the necessity clearly.
5. Initial in one of the boxes to indicate your recommendation for the student to take a reduced course load or no classes at all during the indicated semester.
6. Circle the term(s) for which you are recommending the reduced course load, ensuring to specify the correct semester: Spring, Summer, or Fall, along with the year.
7. Answer the employment question by initialing the appropriate box regarding the continuation of the student’s employment during the reduced course load period.
8. Finally, provide your signature, printed name, date, the name of your office or clinic, along with your contact details including phone number and email address in the specified areas.
9. If applicable, a licensed counselor from the University of Utah Counseling Center must sign the form to acknowledge support for the medically reduced course load.
10. Once all fields are completed, you can save your changes. Decide to download, print, or share the completed form as required.

Take action now and complete your Medical Reduced Course Load Provider Form online today.