SAMPLE LETTER TO SUPPORT A HEALTH WITHDRAWAL
PLEASE NOTE: This must be typed on health care provider’s office letterhead stationary
CONFIDENTIAL
Date: ____________________
Dr. Kevin Charles
Assistant VP/Executive Director
UNH Health Services
4 Pettee Brook Lane
Durham, NH 03824
Dear Dr. Charles,
I am writing in support of a health withdrawal for ____________________________________________
Name
DOB
for the ___________________ semester at the University of New Hampshire because of a diagnosis of
____________________________________________________________________________________.
I have seen this patient on the following dates or period of time: _______________________________
____________________________________________________________________________________,
and I verify and support this health condition as the reason for his/her need to withdraw from UNH.
Further comments:
Sincerely,
[Signature]
health care provider’s name/credentials
To be mailed to the address above, or emailed/faxed to:
kevin.charles@unh.edu
Fax#: 603-862-4259