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To request a medical leave of absence, please go to:

Health Service  

Students should submit the following information for mental health related MLOA requests: 

1. Have your mental health provider complete the for your MLOA request. 
2. Completed release of information form to allow for communication from Áñ—†ÊÓƵ Medicine Student Health Services to Áñ—†ÊÓƵ University Dean of Students. This form can be submitted online through your . 

1. Letter of support for leave from their managing physician (even if it is a Áñ—†ÊÓƵ Medicine Student Health Service physician). The letter or additional documents should include: 
   1. Diagnosis and relevant medical history 
   2. Current treatment 
   3. Treatment plan for medical leave of absence period 
   4. Expected outcome of treatment during the medical leave of absence 
   5. Test results supporting the diagnosis 
2. Completed release of information form to allow for communication from Áñ—†ÊÓƵ Medicine Student Health Services to Áñ—†ÊÓƵ University Dean of Students. This form can be submitted online through your .  

Áñ—†ÊÓƵ Medicine Student Health Service will need all clinical documentation from your providers before a recommendation can be submitted to the Dean of Students regarding your MLOA request. This can be time sensitive, so please allow enough time to gather all necessary documents.

Searle Hall  
633 Emerson Street 
Phone: 847-491-8100 
 

Student Assistance and Support Services (SASS) staff will outreach to you to schedule a meeting.  During this meeting, SASS staff will review your request for the MLOA, talk with you about the MLOA process, and discuss potential impacts of taking a MLOA.  If possible, a decision regarding whether or not the MLOA may be granted will be made during this meeting and shared with you.

• Dean of Students Office
• 601 University Place
• Scott Hall, Lower level
• Phone: 847-491-8430