AMOUD UNIVERSITY

College of Health Sciences

School of Medicine

LETTER OF HEALTH ASSISNTANCE REQUEST OF A STUDENT

 Your Personal information:

1. Name:
2. University ID:
3. Current class year:
4. Phone Number:

 Kindly write (yes) in the category in which you require assistance in. Note that both can
be applicable.
Mental health ( ) and/ or Special need assistance ( )

 Details of your Mental health and or special need condition:

Kindly specify in details the main reason you require assistance / special consideration from the
school of medicine. Include the duration and how it effects your learning.

 Attachments of photos/files to proof your health condition if you have already contacted
a doctor (if applicable);
Kindly scan and upload in the attachment any evidence you have to aid in your request.