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Application For Medical or Hardship Withdrawal

A student who has a hardship or medical emergency that prevents the completion of all classes for that term may request a Hardship or Medical Withdrawal through the Dean of Students Office. It should be noted that a Hardship or Medical Withdrawal can only be requested after the designated withdrawal date and by midnight of the last day of classes. A student wanting to withdraw before the designated withdrawal date must follow the Withdrawal from Courses Policy outlined in the Undergraduate and Graduate Catalogs.

Before a Medical or Hardship withdrawal, please discuss with your professor your opportunity to complete missed course work and your opportunity to pass the class. In some instances, professors will approve an incomplete grade for the semester and develop a plan to complete assignments in order to provide a final grade in the course. It is awlays recommended that you work with your professor to complete your courses and earn a grade rather than withdraw fully from the semester. To review the Incomplete Grade Form, click here.

Lasly, supporting documentation should be items such as medical reports, police reports, obituaries, birth certificates, etc. and must include your name and date of hardship on the documentation. Pictures of family members, car accidents, body images, etc. that cannot be used to cross reference your involvement and the date of the hardship will not be considered.

Background Information

Which type of Withdrawal?(Required):

This field is required.

Term withdrawing for:(Required):

This field is required.

Learn more

ex. Fall 2019; Spring 2020; Summer 2020

Demographic Information

Your Full Name

VSU Student ID Number (870#)

Date of Birth

Cell Phone Number

VSU Email Address

Questions:

Date of onset of hardship:(Required) This field is required.

Last date able to attend classes:(Required) This field is required.

1. Please provide (or copy and paste) a list of the courses that you are requesting to withdraw from. Include course and section numbers. (Example: ACCT 2101 A7)(Required) This field is required.

2. Please provide (or copy and paste) a detailed statement in regards to your request. The statement should provide an explanation of hardship or medical impact and context for your request. Be as detailed as possible as this information will assist in making a decision of acceptance.(Required) This field is required.

Please provide an explanation as to why you did not withdraw from classes prior to the mid-term withdrawal date.(Required) This field is required.

3. I understand that a withdrawal impacts my attempted hours for financial aid. I understand that it is my responsibility to contact Financial Aid and the Bursar's Office to find out about adjustments to my account associated with a medical or hardship withdrawal.(Required)

I understand

You must make at least one selection.

4. I understand that a medical or hardship withdrawal may cause my housing contract to be canceled and I might be required to move out of the residence hall. In order to move back into on-campus housing, I must reapply.(Required)

I understand

You must make at least one selection.

5. I understand that the University may choose to verify any of the documents that I have submitted. As indicated by my approval below, I ask that the appropriate officials consider this my electronic signature and cooperate with the University as needed on my behalf.(Required)

I understand

You must make at least one selection.

6. I understand that any false or fraudulent statement(s) made knowingly and willfully by me on the application or any documents attached may subject me to conduct sanctions in accordance with Valdosta State University Student Code of Conduct. Further, I certify that, to the best of my knowledge, the information submitted on the application is true and complete.(Required)

I understand

You must make at least one selection.

Please submit supporting documentation below. Supporting documentation should be items such as medical reports, police reports, obituaries, birth certificates, etc. and should include your name and date of hardship on the documentation. Pictures of family members, car accidents, body images, etc. that cannot be used to cross reference your involvement and the date of the hardship will not be considered.(Required)

I have submitted supporting documentation

You must make at least one selection.

I understand that I can not obtain a medical or hardship withdrawal if I have an active Student Conduct or Title IX case pending investigation. Violating the Student Code of Conduct is not considered a hardship.(Required)

I understand

You must make at least one selection.

Supporting Documentation

Please attach relevant documentation that supports your request for withdrawal based on a medical or hardship. This must be included where available to support your withdrawal statement. (Ex. Doctors note with dates of care. Obituary. etc.) Supporting documentation should be items such as medical reports, police reports, obituaries, birth certificates, etc. and should include your name and date of hardship on the documentation. Pictures of family members, car accidents, body images, etc. that cannot be used to cross reference your involvement and the date of the hardship will not be considered. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.