Let’s hear it for the next stage of Andrew’s Life
Medical Leave of Absence Protocol
The purpose of a medical leave of absence (MLOA) is to provide students time away from campus for treatment of a physical or mental health condition that impairs a student’s ability to function safely and successfully as a member of our community. The authority to grant a MLOA and permission to return from a MLOA resides with the Dean of Students Office. This protocol applies to both undergraduate and graduate students. Each leave is individualized based on the needs of the student and handled on a case-by-case basis.
Approval for MLOA
Reinstatement to the University
Relevant Medical Forms
APPROVAL FOR MLOA
Contact the Counseling and Psychological Services (CAPS) or Health Services
The student must schedule an interview for reinstatement with CAPS (for mental health reasons) or Health Services (for physical health reasons) and provide documentation of treatment efforts/resolution. Your interview as well as any supporting documents must be completed no later than 5pm on the Friday of the 8th week of the quarter.
CAPS, Searle Hall 633 Emerson, second floor
ph: 847.491.2151; website:www.northwestern.edu/counseling
Health Services, Searle Hall 633 Emerson Street
ph: 847.491.8100; website: http://www.nuhs.northwestern.edu
Check on Financial Aid Status
Financial Aid can be impacted while on a MLOA. Federal student loans go into repayment after the expiration of the grace period (6 months) if the student is not at least a half time student, so a leave may diminish or wipe out the grace period, and your repayment may begin immediately upon graduation. Please consult the Office of Financial Aid to determine the effects a MLOA may have on a student loan.
Office of Financial Aid, 1801 Hinman Avenue
ph: 847.491.7400; website: http://ug-finaid.northwestern.edu; email: email@example.com
Check on Health Insurance
If a student takes a MLOA, s/he is no longer enrolled full time at the university. This change in status may have implications on your eligibility for health insurance. Please consult your family or health insurance provider. Students on the university health insurance plan should consult:
Student Insurance Office, Room G.125b, Health Service, Searle Hall, 633 Emerson Street,
ph: 847.491.2113; website:www.northwestern.edu/evanston/insurance.aspx
Contact the Dean of Students Office (DOS)
After the CAPS or Health Services evaluation, the student should contact the DOS and submit the signed Medical Leave of Absence Protocol (PDF). You can download, sign the form and return it to the Dean of Students Office. See Relevant Medical Forms.
Dean of Students Office, 601 University Place, Room 40
ph: 847.491.8430; website: http://www.northwestern.edu/studentaffairs/dos
Students must complete all necessary paperwork by 5pm on the Friday of the 8th week of the quarter. Any request submitted after that date may be considered for the following quarter. Once approved, a Student Affairs hold will be placed on your student account at this time.
The DOS will notify the student in writing of the determination. The DOS will notify parents and other university departments of the student’s change in status.
Departure from University Housing
A student will be required to vacate university housing within 48 hours of the approval of the leave, which includes removal of all belongings. The student must complete a request to cancel his/her residence and board contract with Undergraduate Housing. The student must also officially check out of the residence hall by completing the Room Condition Inventory and return all keys to a member of the Residential Life Staff. Failure to properly check out may result in additional changes.
University Housing Office, Seabury Hall, Room 225, 600 Haven Street
ph: 847.491.7564; website: http://www.northwestern.edu/living; email: firstname.lastname@example.org
University Residential Life, Scott Hall, Room 10, 601 University Place
ph: 847.491.3541; website: http://www.northwestern.edu/living; email: email@example.com
While on MLOA, a student may not register for classes at Northwestern until the student has been reinstated by the DOS and the Student Affairs hold has been removed. It is strongly encouraged for students on medical leave to consult their academic dean’s office and advisor in advance and have an academic plan for classes so course registration can occur as soon as the hold is removed.
REINSTATEMENT TO THE UNIVERSITY
Information Required by CAPS or Health Services
The student must schedule an interview for reinstatement with CAPS (for mental health reasons) or Health Services (for physical health reasons) and provide documentation of treatment efforts/resolution. These interviews must be completed 6 weeks prior to the first day of the anticipated quarter of return.*
CAPS, Health Services, Searle Hall 633 Emerson – second floor
ph: 847.491.2151; website: http://www.northwestern.edu/counseling
Health Services, Searle Hall 633 Emerson
ph: 847.491.8100; website: http://www.nuhs.northwestern.edu
To facilitate the reinstatement process, the student’s health care provider(s) must provide CAPS or Health Services with a detailed summary of treatment the student received during the MLOA.
Health Information. Each health care provider must provide the following information to CAPS or Health Services:
All relevant psychological and/or physical information regarding the condition that percipitated the leave as requested by either CAPS or Health Services;
Confirmation of the student’s ability and readiness to successfully transition back into the university;
Treatment plan or recommendations for student once s/he has returned to campus
Authorization for the Use and Disclosure of Protected Health Information The student must sign and date a release to allow CAPS or Health Services to speak to the student’s health care provider(s) and with the DOS.
Evaluation of Health Information
CAPS or Health Services will provide the DOS with a recommendation regarding the student’s physical and/or psychological readiness to return to the university.
Complete and submit a Reinstatement Form to the DOS.
The DOS will make a determination regarding reinstatement based on the recommendation provided by CAPS and/or Health Services. Reinstatement is based on the student’s readiness to manage an academic course load and safely function in our community. The DOS will notify the student in writing of the determination, and if approved, whether any conditions will apply. If reinstatement is denied, the student may appeal the determination.
If reinstatement is denied, the student may appeal the determination to the Vice President for Student Affairs (or his or her designee) in writing within ten (10) business days of the decision. The appeal should be made in writing and should set forth the basis for the appeal. The Vice President for Student Affairs shall review the record and any additional information submitted by the student and render a decision within ten (10) business days of receiving the appeal. The Vice President for Student Affairs’ decision shall be final. The Vice President for Student Affairs may extend the time limit for her/his decision as necessary.
Complete the FRET Form
If reinstatement is approved, complete the FRET Form and submit it to your academic dean’s office.
Medical Leave of Absence Protocol (PDF)
Medical Leave of Absence Reinstatement Form (PDF)
Former Student to Re-enter (FRET) Form (PDF)
*If you applying for reinstatement for the Winter 2013 Quarter, all necessary paperwork (including your interview with CAPS) must be completed by Monday, November 26th at 5pm (CST).