LEAVE OF ABSENCE REQUEST STUDENT TO ?· LEAVE OF ABSENCE REQUEST A leave of ... the Office of International…

Download LEAVE OF ABSENCE REQUEST STUDENT TO ?· LEAVE OF ABSENCE REQUEST A leave of ... the Office of International…

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<ul><li><p> 7/8/16Version</p><p>LEAVEOFABSENCEREQUEST </p><p>Aleaveofabsencerequestmaybegrantedforuptooneyearatatime.Aleaveofabsencemustbeapprovedbyastudentsfacultyadviser(ordivisiondirectorinthecaseofPSLstudents)andtheViceDeanofAcademicAffairs.Theapprovalofafacultyadviser/divisiondirectorandtheViceDeanofAcademicAffairs isalsonecessaryforastudenttoresumehis/herprogramofstudy.Priortocompletingthis form,pleasesetupanappointmenttodiscussthe leaveofabsencerequestwithyourfacultyadviser/divisiondirector.FormoreinformationonSOEsLeaveofAbsencepolicy,pleaseviewhttp://www.students.education.jhu.edu/catalog/SchoolAdmin/registration/leave.html.</p><p>STUDENTTOCOMPLETETHISSECTIONONLY__________________________________________________________________________________LastName(Pleaseprint) FirstName StudentIDAreyouanInternationalstudent?*Yes_____No_____VisaType______________*(StudentswithF-1visasmustcontacttheOfficeofInternationalServicesbeforeleavingJohnsHopkinsUniversity.Perfederalregulations,youmaynotremainintheU.S.ifyouwishtogoonaleaveofabsenceforafinancial,family,ormedicalreasonotherthanyourown.)MailingAddress:(Ifthereareanychangestoyourcontactinformationduringyourleaveofabsenceexpires,pleaseupdateyourpersonalinformationonStudentSelf-Service)Street:__________________________________________________________________________City: ________________________________State:__________ZipCode:_______________Phone:_________________________________JHUEmail:_______________________________ProgramofStudy:_________________________________________Term/YearEntered:__________________FacultyAdviser/DivisionDirector:_________________________________________Reasonforrequestingaleaveofabsence:Academicperformance_____Personal/familyreason_____Financialconsiderations_____Medicalreasons*_____Other______*Appropriatedocumentations,(forexample,aletterfromyourdoctor)mayberequiredbeforealeaveofabsenceisgranted.Additionally,appropriatedocumentation(forexample,aletterfromyourdoctor)mayberequiredtoconfirmyourreadinesstoreturntotheuniversityandresumeyourprogramofstudy.IfyouchooseOther,pleaseexplain(detailinaseparatedocument[e.g.letter]ifneeded):____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________</p></li><li><p> 7/8/16Version</p><p>PleasestatethestartandendofyourrequestedLeaveofAbsence:StartSemester/Year_________________EndSemester/Year______________________**IsthisarequesttoextendaLeaveofAbsence?Yes______No______Ifyes,whendoes(ordid)yourpriorLeaveofAbsenceend?Semester/Year___________________Ifyouaregrantedaleaveofabsencepleasebeawareofthefollowing:</p><p> WithdrawfromCoursesYouwillneedtowithdrawfromanycourses(currentandfuture)inwhichyouareenrolled.Pleasecontactsoe.registration@jhu.eduifyouhaveanyquestionsaboutthisprocess.</p><p> PayYourBillsStudentsareresponsibleforpayingalltuitionandfeesontheiraccount. FinancialAidYoumayhavetobeginpayingbackyourloanwithinterestwhileonleaveofabsence.</p><p>PleasecontacttheFinancialAidofficeatsoe.finaid@jhu.eduforfurtherinformation. JHUStudentHealthInsuranceYouwillreceivecoveragefortheperiodforwhichyouhavealreadypaid.</p><p>CheckwithOfficeofStudentAffairsregardinginsurancequestionswhileonleave.Whenyouarereadytoreturntoyourstudies,pleasecontactyourfacultyadviser/divisiondirectorforguidance.StudentSignature:_______________________________________________Date______________ThissignatureverifiesthatyouhaveprovidedaccurateinformationandunderstandyourfinancialandlegalobligationstotheJohnsHopkinsUniversitySchoolofEducationduringyourleaveofabsence.Onceyoursectionoftheformiscomplete,pleasesubmittheformtoyourfacultyadviser/divisiondirector.Youwillreceiveasignedcopyofthisformnotifyingyouwhetheryourrequestforaleaveofabsencehasbeengranted.</p><p>OFFICEUSEONLY</p><p>FacultyAdviser/DivisionDirectorApproval</p><p>LeaveofAbsenceGranted:Yes____No____</p><p>StartDateofLeaveofAbsence:___________LeaveofAbsenceApprovedUntil:___________</p><p>PrintName:____________________________________________________</p><p>Signature:______________________________________________________Date:________________________</p><p>ViceDeanofAcademicAffairsApproval</p><p>LeaveofAbsenceGranted:Yes____No____</p><p>PrintName:____________________________________________________</p><p>Signature:______________________________________________________Date:________________________</p><p>Copiesofthisdecisionformshouldbesentto:FacultyAdviser/DivisionDirector____ViceDean________StudentAffairs____OIS(forinternationalstudentsonly)____</p><p>TheoriginalLeaveofAbsenceRequestformshouldbesentto:RegistrarsOffice(StudentFile)______</p></li></ul>

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