Guidelines for Medical Withdrawal for Psychological Reasons
(For full description see Student Handbook, Part 4, Ch. 5 Voluntary Medical Withdrawal)

The Medical Withdrawal for Psychological Reasons: General information
A student may request a medical withdrawal from Miami University for psychological reasons if during the course of a term (Fall, Spring, or Summer) he or she suffers from a psychological condition that prevents him/her from performing the essential functions of a student (e.g. unable to attend classes, unable to complete academic responsibilities, etc.) for an extended period of time during that term. The severity and duration of the problem must be such that it would not be reasonable to expect the student to be able to make up the missed work. Requests for a medical withdrawal for psychological reasons must be made in writing by the student to the Director of the Student Counseling Service and must be supported by a licensed mental health professional in the form of a letter documenting the and diagnosis of the student during the term in question and clearly indicating support for the withdrawal. The Director of the Student Counseling Service has the ultimate authority to approve a medical withdrawal for psychological reasons. The student will be notified in writing by the Director or his designee if the request has been approved or denied. A form for requesting a medical withdrawal from the current term, as well as a form for requesting a retroactive medical withdrawal from a completed term, is attached at the end of these Guidelines and may also be obtained online at www.miami.muohio.edu/studentcounseling. If the request for a medical withdrawal for psychological reasons is approved, a medical hold will be placed on the . The medical hold will remain in effect until a mental health professional has submitted a letter to the Director of the Student Counseling Service documenting their improved sufficiently for the student to return to the academic environment without posing a significant risk of substantial harm to him/herself or others, and a lift of the medical hold has been approved by the Director of the Student Counseling Service or his designee. The student should be aware that a medical withdrawal will relieve a student of responsibility for uncompleted academic work but will not provide credit for work completed that term, unless the student has completed and been assigned a passing grade in a sprint course, i.e. any course less than a full term in length, prior to the date of last class attendance for that term. If a student has completed and received a passing grade in a sprint course in the term from which he/she is requesting withdrawal, he/she must so indicate that on the withdrawal request form and indicate a rationale for retaining (Note: t is not possible to receive a medical withdrawal from individual classes while remaining enrolled in other classes. A student may petition the Inter-­‐divisional Committee of Advisers for withdrawal from single or multiple classes after the withdrawal th deadline (9 week of classes) has passed by contacting his/her divisional advisor.) withdrawn term will indicate only officially withdrawn [date] without specifying the nature of the reason for withdrawal in order to protect the privacy of the student. Reimbursement of tuition or fees: Effective July 1, 2012, a student will be provided with a refund of tuition and fees in unless they indicate directly to the Office of the Bursar (513.529.8744) that they prefer to receive a Medical Tuition Credit. A Medical Tuition Credit is a credit in an amount equal to that paid for tuition and general fees for the term of withdrawal less any student financial assistance that must be returned to the financial aid program. A Medical Tuition Credit will be applied to the first term of re-­‐enrollment following the medical withdrawal and must be used within three years. A student is eligible for only one Medical Tuition Credit. Students are strongly urged to consult with the Office of Student Financial Assistance to determine how their withdrawal will affect their financial aid before determining whether to seek a refund or Medical Tuition Credit. Any refund of tuition or fees due the student will be determined from the last date of class attendance, regardless of the date of the onset of the condition prompting the request for the withdrawal. (Note: It is possible that a tuition refund plan may

cover part of the non-­‐reimbursable tuition, for families who purchased such a plan.) Questions regarding these options should be addressed to the Office of the Bursar.

Procedure for Obtaining a Medical Withdrawal for Psychological Reasons:
1. Assessment: The student should complete a psychological assessment by a licensed mental health practitioner (who is not a family member) who will determine if the student is suffering from a psychological condition that is preventing him/her from performing the essential functions of a student. This assessment may be completed by staff at the Student Counseling Service or by other mental health providers qualified to make mental health assessments and diagnoses. 2. Documentation: The mental health professional will then write a letter indicating their assessment of the stud emotional and mental health status; diagnoses (if any); a brief explanation of the circumstances that led to the decision to withdraw; and indication of their clear support for the option of medical withdrawal as being supported by the findings of the assessment. 3. Application: The student should then complete the Request for Medical Withdrawal Form on the last page of this document or available at the Student Counseling Service, or on-­‐line at www.miami.muohio.edu/studentcounseling. This form request, including an explanation of why the condition is sufficiently persistent and serious as to warrant withdrawal from all classes. 4. Submission: The letter from the mental health professional Request for Medical Withdrawal for Psychological Reasons Form should be forwarded to: Dr. Kip Alishio, Director Student Counseling Service 195 Health Services Bldg. Miami University Oxford, OH 45014 FAX: 513-­‐529-­‐2975 Email: alishikc@muohio.edu Submissions faxed or emailed must include original signatures. 5. Notification: If the withdrawal is granted, the student will receive written notification at their permanent address by U.S. mail from the University, indicating that the withdrawal has been successfully processed, that the registration hold is in place, and action to be completed prior to returning to Miami. If denied, similar notification will be sent to the permanent address. 6. Clinical Follow-­‐up: The student should complete ongoing counseling/treatment as agreed to with a mental health professional. It is success, he/she work with a mental health professional toward the goal of returning to academic life only when a functional behavioral plan has been enacted which helps the student to manage stressors and remain active, engaged, and successful at achieving academic goals. He/she should feel emotionally and mentally well prepared for the rigors of returning to school after an absence before applying for re-­‐enrollment. At minimum the student must be evaluated by a licensed mental health professional prior to application for re-­‐enrollment to the university.

 7. Reinstatement: The mental health practitioner should send a letter to the Director of the Student Counseling Service, as above, verifying that the condition which led to the withdrawal no longer prevents the student from performing the essential functions of a student without posing a significant risk of substantial harm to self or others. 8. Notification: Upon receipt of this documentation, the Director or his designee will make a decision regarding re-­‐enrollment and notify the student in writing of that decision. 9. Timing of Requests: All requests for medical withdrawals from the current semester should be completed before the end of the semester and as close as possible to the last date of class attendance. Applications for withdrawal submitted after a semester has been completed are considered Retroactive Withdrawals. Under extraordinary circumstances a student may request withdrawal from a semester that has already ended. The procedures for requesting a Retroactive Medical withdrawal are similar to those required for ordinary medical withdrawal, except these requests will be decided by the Medical Evaluation Committee. The Request for a Retroactive Withdrawal Form is provided below, after the request for a Medical Withdrawal for Current Semester Form: be sure to use the more detailed retroactive request form for these requests. The critical criteria for approval of a Retroactive Medical Withdrawal is that supporting documentation be provided by an appropriate mental health care professional who was involved in the assessment and/o during the term for which the condition is claimed to have prevented the student from functioning. Exceptions to this requirement may be considered if supported by detailed documentation by medical/mental health professionals who were of time (e.g. a few weeks at most) subsequent to the term in question. Application for removal of the hold on registration and reinstatement should also be made in a timely fashion, e.g. as soon as the mental health professional is able to provide the supporting documentation of improvement. Submission of this documentation later than seven (7) days before the beginning of the term may also result in delayed processing and therefore a delay in registration for classes. Appropriate mental health practitioners for the purposes of supporting medical withdrawal or return after withdrawal include: licensed social workers, counselors, psychologists, or psychiatrists (and other medical professionals licensed to make mental health assessments and diagnoses such as family physicians, if sufficient detail is included) who are in good standing in their fields and who do not have a familial relationship with the student. Questions? Please contact the Student Counseling Service at (513) 529-­‐4634. Please keep a copy of these Guidelines for future reference. They are also available online at www.miami.muohio.edu/studentcounseling.

Miami University Request for Medical Withdrawal: Current Semester

Check if this request is for a condition primarily: _____ medical in nature (submit to Medical Director), or _____ psychological in nature (submit to Director of Student Counseling Service Name (Last) (First) (Initial) Year in School Major, Program, or Division Local Street Address Apt. ( ) ( ) City State Zip Phone Cell Phone Home Street Address Apt. ( ) ( ) City State Zip Phone Cell Phone Term and year you are requesting withdrawal from (identify one term only): st nd 1 (Fall)Term 2 (Spring)Term Summer Term / / Banner I.D.+ or Date of last (most recent) class Social Security # (optional) attendance during term indicated Did you receive a grade for a sprint course (i.e. a course less than one full term in length, including any summer term course not lasting the entire summer) during the term from which you are requesting withdrawal? ____yes____no If yes, do you wish to be withdrawn from that course(s) also? ___yes____no (meaning you wish to retain that grade(s)), please list those courses here and indicate why you wish to retain them (e.g. you received a passing grade; your condition had not interfered with your academic performance yet; etc.): ____________________________________________________________________________________________________________________ __________________________________________________________________________ I request consideration for a Medical Withdrawal, based upon the following circumstances (use back if necessary): In requesting this medical withdrawal, I assert that for a significant period during the term indicated my physical, mental, and/or emotional condition has prevented me from performing the essential functions of a student. I have read and discussed the Guidelines for Medical Withdrawal for Psychological Reasons with my health professional. By signing below, I acknowledge that I understand the policies noted therein and my responsibilities in applying for and potentially returning from a medical withdrawal for psychological conditions as well as for related financial implications. Signature in ink Date
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Miami University Request for Retroactive Medical Withdrawal: Previous Semesters

Check if this request is for a condition primarily: _____ medical in nature (submit to Medical Director), or _____ psychological in nature (submit to Director of Student Counseling Service Name (Last) (First) (Initial) Year in School Major, Program, or Division Local Street Address Apt. ( ) ( ) City State Zip Phone Cell Phone Home Street Address Apt. ( ) ( ) City State Zip Phone Cell Phone Term and year you are requesting withdrawal from (identify one term only): st nd 1 (Fall)Term 2 (Spring)Term Summer Term / / Banner I.D.+ or Date of last (most recent) class Social Security # (optional) attendance during term indicated Did you receive a grade for a sprint course (i.e. a course less than one full term in length, including any summer term course not lasting the entire summer) during the term from which you are requesting withdrawal? ____yes ____no If yes, do you wish to be withdrawn from that course(s) also? ___yes ____no ate why you wish to retain them (e.g. you received a passing grade; your condition had not interfered with your academic performance yet; etc.): ________________________________________________________________________________________________________________ ___________________________________________________

_______________________

I request consideration for a Medical Withdrawal, based upon the following circumstances: 1. Please list any medical or psychological/psychiatric diagnoses you have received from professional health or mental health workers within the past five years that are directly relevant to your application: 2. Please describe any physical health or mental health/counseling assessments and/or treatment you sought during the semester for which you are requesting a withdrawal, including:

a. Name/degree (M.D., Ph.D., M.A., LPC, etc.) of the practitioner b. Location/address of the service c. Number/dates of appointments attended 3. Please briefly describe the specific issues or concerns that caused you to seek medical intervention or counseling/ assessment during the semester for which you are requesting a withdrawal: (use back or attach letter as necessary) 4. If you did NOT seek medical diagnosis and intervention, counseling, or assessment from a mental health professional during the semester for which you are requesting a withdrawal, please briefly explain what prevented you from seeking such consultation at that time: 5. Please briefly indicate why you believe you were unable to perform the essential functions of a student during the semester for which you are requesting a withdrawal: 6. Please indicate your accumulated GPA before the semester for which you are requesting a withdrawal (this may be a HS GPA if the requested semester was your first at Miami University): Please indicate the GPA you earned during the requested semester: In requesting this medical withdrawal, I assert that for a significant period during the term indicated my physical, mental, and/or emotional condition has prevented me from performing the essential functions of a student. I have read and discussed the Guidelines for Medical Withdrawal for Psychological Reasons with my health professional. By signing below, I acknowledge that I understand the policies noted therein and my responsibilities in applying for and potentially returning from a medical withdrawal for psychological conditions as well as for related financial implications. Signature in ink Date

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