Medical/Mental Health Withdrawal

Medical Withdrawal from the University

Our role is to collect, review, and verify the documentation that you submit supporting your request for a Medical or Mental Health Withdrawal. UT San Antonio Wellbeing Services will maintain the privacy of your documents throughout this review process. UT San Antonio Wellbeing Services will submit a recommendation to the M/MH Committee after all the documentation has been received and verified. The M/MH Committee will make the final decision regarding each student’s Medical or Mental Health Withdrawal request.

Medical/Mental Health Withdrawal Policy

Medical/Mental Health Withdrawal Application

Complete the Medical/Mental Health Withdrawal Request form and then submit it to Student Assistance Services.

Download the Entire Application

Use the links below to view each section of the Medical/Mental Health Withdrawal Application separately.

  • Medical/Mental Health Withdrawal Request Guide and Checklist
    This Guide for Students     is the cover letter, explaining the reasoning behind all of the Medical/Mental Health Withdrawal Documents. The checklist     helps ensure you have everything you need for a Medical/Mental Health Withdrawal.
  • Authorization To Release Records and Information For Medical/Mental Health Withdrawal Request
    These Authorization To Release Records and Information For Medical/Mental Health Withdrawal Request     allows UT San Antonio Wellbeing Services permission to act on your behalf with the necessary UT San Antonio Departments and to contact your medical provider for the purpose of your Medical/Mental Health Withdrawal.
  • Informed Consent: Medical/Mental Health Withdrawal Requests
    The Informed Consent: Medical/Mental Health Withdrawal Requests     provide explanations of confidentiality, maintenance of records, services offered, and emergency/after-hours resources.
  • Personal Statement
    The Personal Statement     provides instructions on writing your personal statement regarding why you're requesting a Medical/Mental Health Withdrawal.
  • Medical Provider Statement
    The Medical Provider Statement     has instructions for your medical provider on how to provide a statement describing why you need a Medical/Mental Health Withdrawal.
  • Transcript
    A current transcript (i.e. can be an unofficial copy) with the final grades earned during the semester in which you are applying for the Medical or Mental Health Withdrawal. Transcripts can be requested by accessing the Registrar’s Office online.