Get University Of Washington Health Care Provider Verification Form For Tuition Forfeiture Petition 2004-2025

Filling out the University Of Washington Health Care Provider Verification Form For Tuition Forfeiture Petition is an essential step for students seeking a waiver of tuition forfeiture fees. This guide provides detailed instructions on how to complete the form accurately and effectively online.

Follow the steps to complete the form online

1. Click the ‘Get Form’ button to obtain the form and open it in the editing interface.
2. In the first section, enter the name of the student or patient who is petitioning for the waiver. This ensures that the documentation is correctly attributed.
3. Next, provide the student's identification number in the designated field. This number is necessary for the university to trace the student's academic record.
4. The health care provider must detail the condition of the student/patient in the section provided. Specify how this condition prevents attendance at the University during the current quarter. Attach additional sheets if more space is needed for the explanation.
5. Fill in the date of the first visit the health care provider had with the student. This information is crucial for establishing the timeline of the medical condition.
6. Indicate the date of the last examination of the student by the health care provider to validate the current status of the condition.
7. In the statement section, the health care provider must fill in their professional opinion concerning the student’s ability to attend classes due to the stated medical conditions. This should be completed with clear and specific language.
8. The health care provider must sign the form, print their name, provide the date, and include their contact number to confirm the authenticity of the observation.
9. In the consent section, the student must sign and date the document to authorize the release of their medical information to the University of Washington regarding this request.
10. If the student is under 18, a parent or guardian must also sign and date the consent section.
11. Once all sections are completed, review the form for any discrepancies. Save the changes, and then download or print the completed form for submission.

Complete your documents online today to ensure a smooth petition process.