Medical Incomplete

Authorization to release health information to support an academic incomplete for health / medical reasons

If you have been in contact with a Health Services clinician regarding a health related issue that has impacted your ability to complete the semester as expected, Health Services can provide documentation to your Class Dean to support finishing the work after the term ends. Please download, complete and sign (not e-sign) this medical incomplete form and drop it off at Health Services. Your clinician will submit the form to your Class Dean and send you a copy via secure message through the Student Health Portal.