Student Recreation and Wellness Center

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Voluntary Health Withdrawal

UNLV students may apply for a Voluntary Health Withdrawal (VHW), a separation of the student from the university, if they experience medical or psychological conditions that significantly impair their ability to function successfully and safely in their role as a student.

The deadline to request a VHW for Spring 2017 is April 26, 2017.

A student must be enrolled in the current semester to be eligible for a VHW.

A VHW can only be applied to the current semester (before grades are posted).

If a VHW is approved, all classes for the semester are removed from the transcript. The student cannot select “1 or 2” courses – a VHW applies to all courses for the semester or none.

  • After a grade is posted for a course, a VHW cannot override a posted grade. The student would need to petition Faculty Senate.
  • A VHW cannot be retroactively applied to a previous semester.
  • Spring 2017 “Request for a Voluntary Health Withdrawal” documentation must be submitted by April 26, 2017. This deadline is firm.

The VHW policy does not extend to family members who are ill.

  • If a student experiences hardship due to caring for an ailing family member, the student would not request a VHW. The student can submit a petition to Faculty Senate in this instance.

Download and work with your Health Care Provider to complete the forms, found in the pdf link to the right.

Procedure to Request a Voluntary Health Withdrawal (VHW)

Forms required to process a VHW:

  • Student Checklist for Requesting a Health Withdrawal
  • Request for a Voluntary Health Withdrawal form
    (to be completed by the student)
  • Health Care Provider Evaluation Summary for Health Withdrawal form
    (to be completed by the health care provider(s))
  • Authorization for Release of Protected Health Information form
    (to be completed by the student with provider’s information completed)

These four (4) forms are all required by the Health Withdrawal Committee. A student may submit additional supporting documentation if he/she would like, but additional documentation does not replace the four (4) forms listed above.

Submit Completed Forms

Via fax
(702) 895-4316

In Person
Student Wellness Center Front Desk
Located in the SRWC - the entrance is on the 1st floor, across from the restrooms and water fountains. DO NOT turn your forms in to the desk where you enter the gym.

By Mail
University of Nevada, Las Vegas
c/o MaryEllen Costanza
Box 452005
4505 S. Maryland Parkway
Las Vegas, NV 89154-2005

*Review of request and subsequent processing, if approved, may take 14-28 college working days.

If a request for a VHW is approved, the Health Withdrawal Committee will work with the Office of the Registrar and Student Accounts. No protected health information will be shared; only information about approval of leave of absence will be shared with other campus units, as needed.

  • The student is placed in “Leave of Absence”(LOA) status.
  • traces of the classes registered for in that semester are removed, nothing will show on the transcript for that term.
  • Process a tuition refund for credit hours, if applicable.
    • Please note: special fees cannot be refunded.
    • If the student received financial aid or a scholarship, the student should contact the Financial Aid Office at 702-895-3424.
    • Requesting and receiving a VHW does not absolve the student from Financial Aid policies and responsibilities and Financial Aid funds used to pay tuition and fees is unlikely to be “refunded” to the student.

Procedure to Request to Return from a Voluntary Health Withdrawal (VHW)

If a VHW is approved, the student is placed in “Leave of Absence” (LOA) status. The student must complete “Request to Return” paperwork and be approved to return, in order to register for courses in the future.

Forms required to return from VHW:

  • Request to Return from a Voluntary Health Withdrawal form
    (to be completed by the student)
  • UNLV Medical/Mental Health Clearance form
    (to be completed by the provider(s))
  • Authorization for Release of Protected Health Information form
    (To be completed by student with provider’s info filled out)

Forms are mailed to the student with their VHW approval letter, after the initial process has been completed. The student can contact MaryEllen Costanza by email at [email protected] or by phone at 702-895-0136 to request the forms be sent via mail or email.

If a student requires assistance with the voluntary health withdrawal policies and procedures, the student can contact MaryEllen Costanza.

Petitions and Appeals

If a Voluntary Health Withdrawal is not a viable option, a student may complete a petition or an appeal form, in attempts to remove courses from the transcript or request a tuition refund.

Instructions can be found at the following websites:

The Faculty Senate Petition and Tuition and Fee Appeal Forms are options instead of requesting a Voluntary Health Withdrawal.

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