Fillable Clarion University dical Withdrawal Reinstatement from Me Student (Clarion University of Pennsylvania)

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Clarion University dical Withdrawal Reinstatement from Me Student (Clarion University of Pennsylvania)

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Revised for use 9/2018
Reinstatement from Me
dical Withdrawal
Student Procedures Checklist
Clarion University
840 Wood Street
Clarion, PA 16214
W
hen you are ready to return to Clarion University:
□ Complete reinstatement of medical withdrawal (Part II). The form is available online a
t
(
http://www.clarion.edu/academics/registrars-office/)
□ Obtain documentation and signature from a licensed healthcare professional, M.D. or M.O. outside of
t
he University, attesting to the fact that you are ready to return to the University. Make sure that all o
f
th
e requested information is included.
□ Submit the completed form with signature(s) to the Registrar’s Office. You will also need to apply for
readmission through the Registrar’s Office. The form is available online a
t
(ht
tp://www.clarion.edu/academics/registrars-office/)
□ Review the Withdrawal Reentry Plan that will be provided to you by the Registrar’s Office after you
r
r
eadmission paperwork is processed.
□ Contact your advisor or department chair to discuss what classes you should enroll in once your
readmission paperwork is processed.
□ Make housing arrangements or other arrangements related to your return back to the University.
□ If you are a recipient of financial aid, you will need to contact the Financial Aid Office (116 Becht Hall) to
discuss future financial aid.
All offices—Financial Aid, the Registrar’s Office, etc., will be notified that you are a “readmitted student.”
Reinstatement from Medical Withdrawal - Part II
Clarion University
840 Wood Street
Clarion, PA 16214
Name
Clarion ID___________________________
Part II: Reinstatement Certification
I am requesting to return to Clarion University for the semester/year. I give my
full consent to allow the Provost’s Office to contact the licensed healthcare professional outside the University
listed below.
Student Signature Date
The
student above has been cleared medically and has completed recommended actions. I certify that the
student is medically able to attend Clarion University for the
appropriate documentation is attached.
Comments or restrictions:
semester/year,
Name, Title, State and License # of healthcare professional (M.D. or D.O.) recommending medical reinstatement
Signature Email Phone Date
DO NOT WRITE BELOW THIS LINE – OFFICAL USE ONLY
Approved to Return (Hold Removed) Not Approved to Return
Comments
_________________________________________________
Provost's Signature Date
Documentation must be appended to this form in order to effect the medical withdrawal or reinstatement.
A copy of the form, Part I, should go to the student. The original stays with the Registrar’s Office. Once a
student comes back, s/he should take a copy to the licensed healthcare professional, M.D. or D.O to be
cleared (Part II). Again, a copy is given to the student, and the original stays in the Registrar’s office.
Revised for use 9/2018
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Clarion University dical Withdrawal Reinstatement from Me Student (Clarion University of Pennsylvania)

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Completed 19 August 2020

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