Request for Reactivation from LOA Form

REQUEST FOR REACTIVATION FROM LEAVE OF ABSENCE FORM

This form is to be used to request reactivation from a leave of absence that extends beyond 180 calendar days.

Name*

First Name

Last Name

ID Number*

Please enter your Datatel student ID number found under "My Profile" in the student menu on IONLINE. NOTE: Leading Zeros are not required.

Email*

Confirm Email *

Please inlcude your email address for confirmation of receipt.

Program*

Please select your current program.

School of Nursing students must choose one of these options*

Pre-Licensure BSN or DEN Post-Licensure MS or CAS DNP

Semester you will return*

Please enter the semester in which you plan on returning and registering officially.

Today's Date*

Your signature*

Use your mouse or finger to draw your signature above

Please make note:

As stated in the MGH Institute of Health Professions Catalog: If a student desires to interrupt the defined program of study for at least one academic semester, then s/he must request a leave of absence. It is the student's responsibility to complete a "Withdrawal/Leave of Absence" form and obtain the necessary approvals. Students are allowed a maximum of one year of leave but, if a leave extends beyond 180 calendar days, the status of the leave will be changed to Leave of Absence/Withdrawal for title IV Financial Aid Purposes. Students in this category complete this form to be re-instated.