Graduate Student Leave of Absence Extension Request

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Fall2015 KriegerSchoolofArtsandSciencesWhitingSchoolofEngineeringGraduateStudentLeaveofAbsenceExtensionRequest Topetitionforanextensiontotheirapprovedleaveofabsence(LOA),HomewoodgraduatestudentsonLOAmustsubmitthisformtotheirdepartmentchairand,inthecaseofinternationalstudents,totheOfficeofInternationalServiceforrecommendation,priortoitsfinalsubmissiontotheKSASDeansOfficeortheWSEDeansOfficeofAcademicAffairs.Aletterofexplanationaddressingoneofthepermittedreasonsthegraduatestudentshouldremainonaleaveofabsence(listedbelow)mustaccompanythisform.ThefinaldecisionismadebyeithertheViceDeanforEducation(WSE)ortheViceDeanforGraduateEducation(KSAS).Graduatestudentsmayapplyforuptofoursemestersofleaveofabsencewhenmedicalconditions,compulsorymilitaryservice,orpersonalorfamilyhardshippreventsthemfromcontinuingtheirgraduatestudies.Tobeapprovedforanextensionoftheirapprovedleaveofabsence,graduatestudentsmustprovidetheproperdocumentationfortheirgivensituation,asindicatedbelow:MedicalCondition:aletterfromaphysician(thismaybealetterfromadoctorattheStudentHealthandWellnessCenter),ortheCounselingCenterMilitaryService:aletterorverificationfromtheArmedForcesPersonalorFamilyHardship:aletterfromtheapplicantAnyadditionallettersofsupport(e.g.,fromanadvisor,departmentchair,etc.)arewelcome.Financialdifficultyalonedoesnotwarrantaleave.Aleaveofabsencewillbegrantedforaspecificperiodoftime,nottoexceedatotaloftwoyears.TheformwillneedtobesignedbythedepartmentandtheOfficeofInternationalServices(ifapplicable)priortoitssubmissiontotheKSASDeansOfficeortheWSEDeansOfficeofAcademicAffairs.ThefinaldecisionismadebyeithertheViceDeanforEducation(WSE)ortheViceDeanforGraduateEducation,andCentersandPrograms(KSAS).Duringtheleaveperiod,graduatestudentsmaynotbeenrolledatanotheruniversity.Beforeapplying,graduatestudentsshouldconsulttheirdepartmentforinformationregardingfundinguponreturn.WhenonanapprovedLOA,thereisnotuitioncharge;theperiodofleaveissimplyregardedasaninterruptionofthedegreeprogram.Timespentonleaveofabsenceisnottimecountedtowardtimetodegree.REMINDER:Whileonleaveofabsence,graduatestudentsdonothavestudentprivilegesaccesstoUniversityservicesorfacilitiesandstudentemployment.However,graduatestudentsonLOAareeligibleforemploymentthroughtheUniversitysHumanResourcesOffice.DegreeprogressmaynotbemadebystudentswhileonaleaveofabsenceincludingcompletionoftheirdissertationorthesubmissionofthedissertationtoETD.TakingaleaveofabsencemayaffectastudentsJohnsHopkinsStudentHealthInsurance.ItisrecommendedthatstudentsinterestedinapplyingforaleavecontacttheRegistrarsOfficetofindouthowtheircoveragewillbeaffectedshouldtheybeapprovedforaleaveofabsence.Forfederalaidpurposes,astudentonaleaveofabsenceisconsideredtobewithdrawnfromJohnsHopkinsUniversityandwillgointorepaymentoneducationloansoncethegraceperiodisexhausted.Formoreinformation,visithttp://www.jhu.edu/finaid/grads_loans.htmlorcontactyourfinancialaidadvisorathttp://www.jhu.edu/finaid/contact.html.ApplicationtoReturnfromLeaveofAbsenceWhenreturningfromleaveofabsence,agraduatestudentmustcompleteandsubmittheApplicationtoReturnfromLeaveofAbsencebeforeregisteringforclasses.Theformmustbeaccompaniedbyaletter(fromoneofthesourcesbelow)thatexplainswhatprogresshastakenplaceinthestudentsabsencethatwouldenablehim/hertobesuccessfuluponreturn.MedicalCondition:aletterfromaphysician(includingtheStudentHealthandWellnessCenter),ortheCounselingCenterMilitaryService:aletterorverificationfromtheArmedForcesPersonalorFamilyHardship:apersonalletterAnyadditionallettersofsupport(e.g.fromanadvisor,departmentchair,etc.)arewelcome. Fall2015 KriegerSchoolofArtsandSciencesWhitingSchoolofEngineeringGraduateStudentLeaveofAbsenceExtensionRequest Section1:TobecompletedbytheGraduateStudentThisformmustbeaccompaniedbyaletter(fromoneofthesourcesbelow)thatjustifiestheextensionofthestudentsleaveofabsence.HopkinsID#: PrimaryDepartment: _____Name: _____(PleasePrint) Last First MiddlePhonenumber:__________________________________JHUEmailaddress1: 1. Iamseekingthefollowingdegree: MastersDoctoral2. Iamaninternationalstudent: Yes1No3. Reasonformyleaveofabsence(checkone):MedicalConditionPersonalorFamilyHardshipMilitaryService4. Ihavealreadycompleted1234semester(s)ofLOA. 5. Irequestpermissiontoextendmyleaveofabsenceforthe___________semester,andamplanningonreturningbythe____________semester. GraduateStudentsSignature Date:____________________ IhaveincludedthemandatorydocumentationsupportingmyrequesttoextendmyLeaveofAbsenceStatus IunderstandthatifIamonanMLOA(medicalleaveofabsence),thatthereisatimelimitonmyeligibilityforthestudenthealthinsuranceplan.IhaveconsultedwitheithermyAcademicAffairsofficeorHealthInsuranceDeskintheregistrarsofficeandunderstandmyoptionsandobligations. Section2:TobecompletedbytheGraduateStudentsDepartmentandOIS(ifapplicable)RecommendedBy Date DepartmentChairRecommendedBy Date OfficeofInternationalServices(ifapplicable)1AfterthecompletionofSections1and2,theDepartmentAcademicStaffmustuploadtotheappropriateOfficeofAcademicAffairsviaaJHBoxUploadSection3:tobecompletedbytheOfficeofAcademicAffairs(KSASorWSE)ApprovedBy Date WSEViceDeanforEducation/ViceDeanforGraduateEducation,andCentersandPrograms Approvalwillbesentviaemail.1OISsignaturerequiredforinternationalstudents.1CKHopkins ID: Phone number: JHU Email address1: Masters: Yes1: Doctoral: No: Medical Condition: Personal or Family Hardship: Military Service: Graduate Students Signature: I have included the mandatory documentation supporting my request to extend my Leave of Absence Status: I understand that if I am on an MLOA medical leave of absence that there is a time limit on my eligibility for the: Recommended By: Recommended By_2: Date_2: Approved By: Date_3: Student's Primary Department: Last Name, First Name, Middle Initial: 4: 3: 2: 1: Semester/Year: Student Signature: Date: Date5:

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