Leave of Absence Request for Health Reasons
This document is a sample letter to support a leave of absence from the University of New Hampshire for health reasons. It provides a structured format to communicate the patient's health condition. This letter must be typed on healthcare provider letterhead.
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How do I fill this out?
To fill out this form, start by entering the date at the top of the letter. Next, provide the patient's name and date of birth. Finally, specify the health diagnosis and detail the appointment dates that validate the leave request.
How to fill out the Leave of Absence Request for Health Reasons?
1
Type the date at the top of the letter.
2
Fill in the student's name and date of birth.
3
Specify the health diagnosis of the student.
4
List the appointment dates with the healthcare provider.
5
Sign the letter and include the provider's credentials.
Who needs the Leave of Absence Request for Health Reasons?
1
Students requesting a health-related leave of absence.
2
Healthcare providers documenting their patient's condition.
3
Academic advisors needing to validate a student's leave.
4
Administrative staff processing leave requests.
5
Parents supporting their child’s leave for health reasons.
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What are the instructions for submitting this form?
To submit this form, email the completed letter to michael.blackman@unh.edu or fax it to 603.862.3550. Ensure that all fields are filled out correctly and that the letter is printed on healthcare provider letterhead. For best results, submit the request well in advance of the semester to ensure sufficient processing time.
What are the important dates for this form in 2024 and 2025?
While specific dates for submitting leave of absence requests vary each semester, it is generally advisable to submit your request at least a month before the semester begins. Be mindful of any university deadlines related to health leave applications.
What is the purpose of this form?
The purpose of this form is to facilitate a structured request for a leave of absence from the University of New Hampshire due to health issues. It serves as official documentation from a healthcare provider, verifying the need for time away from academic responsibilities. Using this form helps streamline the approval process with the university's administration.
Tell me about this form and its components and fields line-by-line.
- 1. Date: The date the letter is being written.
- 2. Student Name: The full name of the student requesting the leave.
- 3. Date of Birth: The birth date of the student.
- 4. Diagnosis: The medical condition that necessitates the leave.
- 5. Appointment Dates: Dates of consultations with the healthcare provider.
- 6. Physician's Signature: The healthcare provider’s signature and credentials.
What happens if I fail to submit this form?
Failing to submit this form can lead to a denial of the leave of absence request, resulting in academic repercussions. It is important to submit the letter as early as possible to ensure timely processing. Not following the required protocol may also impact the student's enrollment status.
- Delayed Approval: A late submission can result in delays in processing the leave request.
- Academic Penalties: Failure to submit may incur penalties such as failing grades.
- Lack of Communication: Without proper documentation, there may be misunderstandings with university administration.
How do I know when to use this form?
- 1. Health Issues: To formally request leave due to a medical condition.
- 2. Therapeutic Reasons: When prolonged treatment is required.
- 3. Mental Health: For taking time off to address mental health concerns.
- 4. Surgery Recovery: If undergoing a medical procedure that necessitates time off.
- 5. Chronic Conditions: For managing long-term health challenges that affect academic performance.
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