Degree Student Medical Withdrawal Form

***It is currently Student Add/Drop Week for Winter 2020 semester. We are not accepting medical withdrawals at this time. If you would like to drop a course(s), please login to your account. If you would like to drop from the semester (drop all courses), please contact your academic advisor at*** 

***ONLY request to be withdrawn from the college will be accepted at this time***

Please fill out this form if you wish to withdraw from a course(s), or the semester due to medical reasons. You must include documentation from a medical doctor in support of your medical withdrawal request. 
Choose course if you are withdrawing from some of your registered courses. Choose semester if you are withdrawing from all registered courses.
For a course withdrawal, list which course(s):

A medical withdrawal will be considered only if accompanied by written verification from a medical doctor on letterhead stating that you cannot complete a course(s), or the semester due to an illness or disability . For your privacy, please do not submit medical records, evaluation, or tests.

Student Authorization:

I authorize Berklee Online to review my medical information for the purpose of medically withdrawing for this current semester. I understand that this information will be handled in a confidential manner and in compliance with HIPAA. I acknowledge that the information provided on this form is accurate as I know and understand it.