Vermont Law School
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Leave of Absence Request Form



First Name: *
Last Name: *
VLGS ID Number: *
Address:
(during leave)		 Street 1: Street 2: City: State: Zip:
Phone:
Your Non-VLGS Email: *
On what date did you last attend classes or log in to the LMS system?

I hereby request a leave of absence from the following program(s): *

Are you a Joint Degree student?     Yes     No    
The Registrar has the authority to grant non-medical leaves of absence for only one year for Juris Doctor degree candidates who are not in mid-term. If a student requests a leave during a semester, s/he will be required to apply to the Committee on Standards. If the requested leave from the J.D. program is for one semester, you will no longer be part of a class upon your return and, therefore, will no longer be part of the class rank process. Master and LL.M. degree candidates must resume their studies in time to complete their programs within the five-year rule. Requests for additional leaves must be made to the Committee on Standards. Please note that online learning students may return earlier to the program with prior approval of the Program Director.

The Registrar's Office does not have the authority to grant a Medical Leave of Absence from Vermont Law and Graduate School. All requests must be approved by the Vice Dean for Students. Your request must be supported by appropriate medical documentation that is provided within 60 days of the date of the initial request but no later than 30 days after the end of the semester. Permission to return to campus following a medical leave of absence must be supported by appropriate medical documentation which states you are healthy enough to continue your studies, and must include a written plan to manage the underlying condition while in school.
Type of Leave: *

Reason for Request:
Documentation:

Anticipated Effective Date of Requested Leave: * (MM/DD/YYYY)

When do you expect to resume your studies?     Spring     Summer     Fall     Year
Information Collection Disclosure:

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NB: Submitting this form acts as your signature on this document.