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Petition and Medical Withdrawal Form

The purpose of this form is to initiate a review of your records towards account resolution. Your request will be reviewed by the Record Review Committee comprised of various members of administrative departments at Goodwin College.

This form is not intended for requests to waive late registration fees; these inquiries will not be reviewed.

Is this a medical withdrawal?

Goodwin College, upon request and with appropriate documentation, may medically withdraw students from their courses due to serious medical conditions that prohibit the student from completing their courses. Students are required to complete a course withdrawal form with their advisor to withdraw from their courses. The request for withdrawal and relevant documentation must be received by the module or semester withdrawal date as indicated in the College catalog. In addition, Medical Withdrawals may affect a student’s academic progress. Please refer to the Satisfactory Academic Progress section in the catalog. Medical Withdrawals will be reviewed by the Record Review Committee (RRC) and will be notified via their Goodwin College email.

Please describe your issue or concern in the space below. Be as specific as possible by indicating particular semester, year, course, etc. In addition, please list any dates and/or Goodwin College staff members who may have played a role in your situation. Forms that are not completely filled out will be returned and not considered until they are complete.

Submitting this medical withdrawal petition does not guarantee a favorable outcome. You will receive notification via the email address indicated above within 30 days from the date the form is submitted. An appeal’s process is available at the conclusion of the committee’s decision. Please refer to the Appeals and Grievances section of the Goodwin College catalog.