Leave Of Absence Request Winter 2021

A leave of absence (LOA) is available to students based on a medical or psychological need. If a student is not eligible for an LOA, there are additional options for a student who does not wish to attend as a fulltime student. Please see the various registration options here.

All Winter 2021 LOA requests must be submitted through this form by Friday, January 8, 2021. If an LOA is granted, the student must register as a full-time student in the semester immediately following the leave semester.

Please note additional deadlines are still applicable (e.g. registration, tuition, etc.).

Following is the criteria for a student to be considered for an LOA:

An LOA may be granted based on the student's physical or mental health need, as supported by a medical professional or through BYUH Disability Services. The student can work with BYUH Counseling & Disability Services or Health Services to obtain the necessary documentation.
The student must be a current continuing student.
The student must have completed two consecutive semesters at BYU–Hawaii as a fulltime student in the previous two semesters immediately before the leave semester and must enroll as a fulltime student in the semester immediately following the leave semester.
The LOA cannot be taken during the student’s last semester in school.
The student is encouraged to counsel with the offices listed below to understand the impact of their LOA. Students are responsible for the information and impact of the LOA that is discussed as well as those not currently anticipated.
Once the student has discussed their LOA with the offices below, they are encouraged to make and submit a plan for the LOA. The plan should include the reason for the request and should demonstrate how the student has planned to meet their financial needs, comply with visa requirements, and meet any other obligations that will affect the time on leave. This statement will be carefully considered when evaluating the request for a semester LOA.
The request will be reviewed by the Dean of Students and a determination made. The student will be contacted with the decision at the “BYU–Hawaii Email” listed below.

Leave of Absence Request

BYUHID#

Name

BYUH Email

Reasons for LOA

Please share your reasons for seeking a Leave of Absence. Please note that only leaves based on a documented medical or psychological need can be approved. Click here for more enrollment options or see your academic advisor.

Home Country

Where do you plan on being during the Winter 2021 Semester?

Semester on Leave

Are you a student on the IWORK program?

F-Visa Holders: Have you been enrolled as a full-time student during both the Fall 2020 and Winter 2021 Semesters?

Please mark the boxes below to acknowledge your completion of the task.

I have a letter from my treating therapist or physician or from Counseling & Disability Services supporting this request for a LOA based on a physical or mental health need. I am attaching a copy of this document below.

File Upload

Statements

Academic Advising

I understand that I may not take any classes during the Leave of Absence. If granted a leave of absence, I understand that I must enroll as a full-time student in the semester immediately following the semester leave. I have reviewed my MAP with my academic advisor and understand how this LOA will affect my MAP. If the LOA is beyond my 4-year allotment, I can request for an extension.

International Student Services (ISS)

I understand the implications and requirements associated with my visa in taking a semester leave. These implications include medical insurance, employment, housing, etc. I understand that if I am out of the United States for more than 5 months, I will need to renew my DS 2019 or I-20.

Student Medical Benefit (SMB)

I understand that I will not have automatic enrollment in the student medical benefit during the leave semester. I have received counseling regarding the student medical benefit and the effects that a leave will have on my medical coverage. I understand that if I have any unpaid medical bills, I am not eligible for a leave of absence. *** For international students, the ISS website provides a list of options for providers of third-party insurance.

Financial Aid & Scholarship

I have met with a counselor in the Financial Aid Office and understand the implications that a LOA will have on my scholarship(s) and other financial aid. For IWORK students: I have met with a counselor in the Financial Aid Office to have my request considered by the IWORK exceptions committee.

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