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