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The procedures and requirements for students seeking academic relief due to medical issues at the schiffert health center. It includes forms for requesting academic relief, instructions for filling them out, and information about the types of academic relief available. Students must provide thorough and complete medical documentation to support their request.
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Name: ___ ID#: _____________________________ Address: _____________________________________ Telephone#:______________________________ _____________________________________ Email: ___________________________________ Specify semester for requested academic relief: ______________________________________________________ I am requesting the following academic relief through the Medical Review Advisory Committee: ___ Medical Withdrawal ___ Additional Probationary Semester ___ Other _____________________________________________________________________________________ ___ Course Drops ( W grades will NOT be considered )/Incompletes (List Course, Number and CRN number – i.e. Math 1526 – 13243) Course Drops: ___________________________________ Incompletes: _________________________
I understand that the Medical Review Advisory Committee will keep all personal/medical information confidential and that it will not be shared or discussed with academic officials.
Student Signature Date **I have reviewed the student’s request and have the following comments regarding their academics:
Academic Dean Signature Date** If you are an Undergraduate International Student you must obtain a signature from The Cranwell Center. If you are a Graduate International Student you need to obtain a signature from an international advisor at the Graduate School.
Signature Date CC: Dean Revised 1/
I have read and understand the guidelines. I grant permission to the Schiffert Health Center Medical Review Advisory Committee to contact me to clarify my request for academic relief and to review my Schiffert Health Center Medical Records and Services for Students with Disabilities Records. Signature ________________________________________________ Date: __________________________ Approved 8/29/06; Revised 1/25/