Medical Withdrawal Request Form – Division of Student Affairs

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MEDICAL WITHDRAWAL FROM WOU

Requesting a Medical Withdrawal from the university is a major decision. Please be sure to see your Advisor or set up an appointment to talk to someone in Student Success and Advising, the Associate Vice President/Dean of Students or the office of the Vice President for Student Affairs for guidance.

This process and form is only for students requesting a full and complete withdrawal from WOU.

For details please see the Medical Withdrawal policy.

MEDICAL WITHDRAWAL REQUEST FORM

Western Oregon University’s Land Acknowledgement
Western Oregon University in Monmouth, OR is located within the traditional homelands of the Luckiamute Band of Kalapuya. Following the Willamette Valley Treaty of 1855 (Kalapuya etc. Treaty), Kalapuya people were forcibly removed to reservations in Western Oregon. Today, living descendants of these people are a part of the Confederated Tribes of Grand Ronde Community of Oregon and the Confederated Tribes of the Siletz Indians.

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WOU prohibits discrimination on the basis of race, color, sex, national or ethnic origin, age, religion, marital status, disability, veteran status, sexual orientation, gender identity, and gender expression in all programs, activities and employment practices as required by Title IX, other applicable laws, and policies. Retaliation is prohibited by WOU.

MEDICAL WITHDRAWAL FROM WOU

This process and form is only for students requesting a full and complete withdrawal from WOU.

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