Advising Heroes

Medical Withdrawal

What is a Medical Withdrawal?

A student who finds it necessary to leave the university due to a medical nature (i.e., injury, illness, substance-related issues, mental health issues) before the end of a semester must officially withdraw by downloading and filling out the 'Medical Withdrawal Form,' which can be found below in step 1. You can also pick up a copy of the form at Academic Advising Services, located on the 4th Floor in the Reed Library.

Step 1: Medical Withdrawal Form

Step 2: Once you have the form, please note you must visit the following offices and have a staff member from each office sign it

  • Financial Aid (2nd Floor Maytum Hall) - will inform students the implications the withdrawal will have on their financial aid
  • Student Accounts (3rd Floor Maytum Hall) - will provide information regarding how your semester bill will be adjusted as a result of your withdrawal.  Students may not be eligible for all of their financial aid, and this will be discussed when we sign your form.
  • Residence Life (1st Floor Gregory Hall) - will inform students about their card access and will discuss the process required for properly checking-out of the residence hall
  • FSA (1st Floor Gregory Hall) - provides an opportunity for students to ask questions and will ensure timely account cancellations

Step 3: When the form is complete with all mandatory signatures*

  • Return form to Academic Advising Services, 4th Floor - Reed Library  (or)
  • Scan and email with Subject 'Withdraw Form Submission' to

Step 4: Provide Required Documentation to Enrollment & Student Services*

  • Medical Documentation Required

    • an original, signed affidavit from a licensed medical provider, licensed mental health provider or an equivalent healthcare provider (not a relative) on letterhead indicating that the student is unable to continue enrollment, or to continue enrollment in specific courses. The evidence must state that the student’s medical/psychological condition is of sufficient severity to make continued enrollment problematic. If the affidavit does not specify courses in which the student may remain enrolled, the student will be withdrawn from all courses.
*Both steps 3 and 4 must be completed to be eligible for a Medical Withdrawal

Important Information About Your Withdrawal

  • Once a withdrawal is approved, the person is no longer considered a student and must immediately leave campus and, if applicable, officially check out of on-campus housing within 24 hours.

  • A student shall not be exempt from disciplinary proceedings for behavioral infractions which occurred prior to leaving. A withdrawal does not override a student conduct (judicial) referral.

  • International students must consult with International Support Services before withdrawing.

  • Students who are using Military and/or Veteran Benefits should contact Veteran Support Services before withdrawing to determine eligibility for future funding.

  • Students in the Educational Development Program (EDP) should consult with their EDP counselor before withdrawing to determine eligibility for future EDP funding.

If you plan on returning, please read the following for information on how-to and the process for returning.

  • By January 1 (spring semester), May 1 (summer sessions), or August 1 (fall semester) have your licensed treatment provider(s) complete the Questionnaire for Return from Medical Withdrawal | Leave of Absence and send to Enrollment and Student Services (ESS) - 2121 Fenton Hall, SUNY Fredonia, Fredonia, NY 14063 - fax (716-673-3583) or  
  • The Fredonia Counseling Center Clinical Director or Health Center Director or designee will review the documentation indicating your readiness to return to academics and university life.
  • Please also complete and submit the appropriate Health Center or Counseling Center Release of Information form to allow your treatment provider to communicate with the appropriate office at Fredonia. 
  • The appropriate Director (health or counseling) will then make contact with you (by phone or in person) to discuss a wellness plan for return. The appropriate Director will subsequently notify ESS of your readiness to return and ESS will notify the Registrar of your clearance to return. If you haven't already done so, you'll also need to submit your application to Registrar for readmission/reinstatement.   
  • If upon review, the appropriate health service reports to Enrollment and Student Services that the student is not ready for return (per the documentation received), the student will be advised of the recommendation in writing, along with recommendations that will enhance the chance of a positive recommendation when the next request is considered. Students may appeal this recommendation by sending an appeal letter in writing, along with appropriate documentation, to Enrollment and Student Services within 5 business days of receiving notice of the negative recommendation.


What is a Withdrawal?

What is the Not Returning Process? 

What is a Leave of Absence?

What is a Medical Withdrawal?

What is Reinstatement / Readmission?

Things to Consider

Academic Advising Services

4th Floor - Reed Library

phone: 716-673-3188


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