Leave of Absence

Student Leave of Absence Request Form

MD, MRS and PA students can request for two types of leave of absence:

Personal leaves of absence requests are considered on a case-by-case by the Director, Undergraduate Learner Affairs, possibly in consultation with other MD/MRS/PA Program leaders. Leaves will normally be granted for a maximum of one full academic year at a time. Full disclosure of the reasons for the request is expected, and supporting documentation will be required.
Students in good academic and professional standing may request to take an academic enrichment leave. Leaves will normally be granted for a maximum of two full academic years and must be approved by:
- MD Students: Associate Dean, MD Program
- MRS Students: MRS Program leaders
- PA Students: PA Program leaders

MD and MD/PhD Students only:

Read the Regulation and guidelines for leaves of absence from the MD Program before completing and submitting this form.
Extensions beyond approved leave(s) will be considered on an individual basis.
All requirements for the MD program must be completed within eight full academic years from first registration, including leaves of absence and withdrawals from the program.
All requirements for the MD/PhD program must be completed within eleven full academic years from first registration, including leaves of absence and withdrawals from the program.

University of Toronto (U of T) Student Number:

Program and Academy:

Current Year of Study:

Last Name:

First Name:

Preferred Name:

Contact Information:

U of T Email Address:

Alternate Email Address:

Cell Number:

Alternate Phone Number (if available):

Address while on LOA:

Emergency Contact Information:

Name:

Relationship:

Email Address:

Cell Number:

Type of Leave:

Personal (medical/health, maternity, and other relevant circumstances)
Academic Enrichment
LOA Extension. Please explain:

If you are requesting to take an academic leave, please provide information about your academic leave request, including the program details and how it will complement your current studies in the MD/MRS/PA Program and career goals.

Start Date of Leave (YYYY/MM/DD):

Proposed End of Leave (YYYY/MM/DD):

Is there an agreed plan with the Program Director (Foundations, Curriculum, MD/PhD, MRS or PA) for academic reintegration?

Yes
No

Briefly provide details.

Do tuition and fees need to be reassessed by UME Enrolment Services? Briefly Explain reason for reassessment.

Who is submitting this LOA request (list the name and university/faculty email address)?

Student
Faculty
Registrar

Upon approval of a leave, a copy of this form will be emailed to the student, Director, Undergraduate Learner Affairs, Program Director, UME Enrolment Services and, for MD students, Academy Director and Faculty Lead, Student Progress so that all of the necessary next steps to process a leave of absence can be completed.

Students will need to confirm the receipt of the copy of this email in order to complete the process. This will also confirm that students have reviewed the relevant University and Faculty policies (e.g. Time to Complete Program).

Students who were absent for an extended period may be required to modify their original program of study upon their return as changes in courses and programs may occur over time.