Leave of Absence Request Form

Complete this form to request a Leave of Absence (LOA) from a program at Columbia University School Nursing. LOA’s are granted for compelling reasons such as illness, military duty, or parental leave. Requests for COVID-19 leaves will also be considered. Students requesting a Medical Leave of Absence are required to provide supporting documentation from your healthcare provider with this form.

It is recommended that students discuss their LOA request with their Program Director prior to form submission.

Financial Aid packages and awards (including loans and institutional aid) will be impacted by your leave. The Financial Aid Office is involved with the Leave of Absence process and will reach out to the student regarding their Financial Aid package with updates/changes.

Students who receive financial aid (which includes but not limited to: Loans, TAs, Stipends, Grants & Scholarships, external awards) should contact the Financial Aid Office with any questions regarding the package received for the term(s) which they are enrolled in.

You will be contacted to complete Financial Aid Exit Counseling, please be sure to complete it.

Course Completion Policy
Courses are complete once the student has submitted all requirements of the course (projects, papers, exams, etc.) even if the grade has not been posted. Grades of all completed courses will appear on the transcript even if the student withdraws or requests a leave of absence for the term. Any leave of absence or withdrawal requests will be processed once the completed courses grades are posted to SSOL.

Additional things to note:
While on an approved LOA, students are not permitted to enroll in courses, be involved in student groups or Columbia University-affiliated activities, or spend time on campus during leave. Students on leave do not have access to university resources, and the CUIMC ID card and swipe access are deactivated during the leave.

Curriculum and/or program plans are subject to change while a student is on an LOA, such as but not limited to; graduation and course requirements, credit load and course term offerings, and enrollment status. Students are responsible to keep in contact with their Program Director while on leave to ensure they are aware and understand any new academic changes.

Please be advised that programs may be discontinued while a student is on LOA. If a DNP specialty program is discontinued, students may apply for a change of specialty as long as the program has availability and the student is in good academic standing.

Students must be in good academic standing to request an LOA request. If a student is requesting an LOA for the upcoming term, the LOA request will be reviewed at the end of the current term once all grades have been posted to the student’s transcript. Students not meeting satisfactory academic progress will need to apply for re-admission and meet admissions deadlines.

If you have any questions on requesting a LOA, please reach out to the Office of Student Services prior to form submission - contact the Office of Student Services at OSSNursing@cumc.columbia.edu.

Submission of this form will be sent to the Office of Student Services. All requests for leaves are reviewed for approval by the Associate Dean of Student Affairs.

View details on the Leave of Absence policy in the School of Nursing Student Handbook.

Student Information

First Name

Last Name

Phone Number

UNI

CUIMC Email Address

Personal E-mail Address

Local Address

Country

Street

City

Region

Postal Code

Address While on Leave

Country

Street

City

Region

Postal Code

Are you on probation?

Yes

Students on probation are not eligible for a LOA. If on probation and you can not complete your studies at this time, submit a withdrawal request.

Do you receive Financial Aid (which includes but not limited to: Loans, TAs, Stipends, Grants & Scholarships, external awards)?

Yes

Do you live in on-campus housing?

Yes

Contact the Office of Housing Services immediately to discuss a move out timeline. The CUIMC ID card and swipe access are deactivated during the leave.

Are you enrolled in the university's Aetna Student Health Insurance Plan?

Yes

Once you are no longer registered as a student, you are no longer eligible for the university's insurance coverage. Contact Student Health on Haven to discuss how a leave of absence will affect your insurance. Students on an approved medical LOA may be eligible to remain enrolled in the university's Aetna student health insurance plan (additional form submission required through Student Health on Haven).

Program Information

Program Currently Enrolled In:

Leave of Absence Request

I am leaving Columbia Nursing:

Fall

Spring

Summer

Leave Year (ex: 2019)

Are you enrolled in courses during the term you are requesting the LOA?

Yes

If enrolled in courses during the term in which you are requesting a Leave of Absence, you will be withdrawn from all term courses (unless coursework has been completed). The Office of Student Affairs will be in contact with instructors to confirm coursework status. The effective withdrawal date of withdrawal is the date that all required paperwork is submitted to the Office of Student Services. This date determines the amount of tuition reimbursement (if applicable). Please contact the Office of Student Services with questions.

I wish to return to Columbia Nursing:

Fall

Spring

Summer

Return Year (ex: 2020)

Reason for Request

Reason for LOA Request:

Medical

Military

Parental leave (Maternity or Paternity)

Find Employment for DNP N9700 Residency

Other (Specify reason below)

Please elaborate below on your reasons for requesting a Leave of Absence. Your statement should include the reason you are unable to complete your studies at this time, and address how you intend to use your time away. This is required for a Leave of Absence request to be considered.

Students requesting a Medical Leave of Absence are required to provide supporting documentation. Documentation must be from your healthcare provider who has treated you for the condition which occasioned this leave request. This letter must indicate that you are not able to continue in course/clinical work at this time.

Upload Supporting Documentation (Required for Medical LOA Request)

Student Statement of Responsibility

I have reviewed school policies related to this request, and I understand that a leave of absence may jeopardize my graduation date and/or financial aid package. I also understand that I may be asked to submit additional documentation to support this request, and that my request for a Leave of Absence may be denied.

Electronic Signature: