The Ohio State University College of Nursing

M.S. in Nursing Program(also BSN to PhD or BSN to DNP)

Request for Leave of Absence (LOA)

A student who plans to request a Leave of Absence (LOA)should submit the request in writing to the Graduate Studies Committee by notifying the academic advisor and specialty track program director (SPD) whose acknowledgement signatures are required on this form, completing this form, and providing the additional supporting materials listed below. The LOA request form should be completed for any requested absence of at least one semester, with the exception of Summer Term if the student is not scheduled to take classes.

A Permission to Reactivate Enrollment Eligibility form ( must be completed and submitted to ith a brief statement in advance of the proposed semester of re-enrollment. Approval of the reactivation request is contingent on available space for clinical placements and is not able to be guaranteed for a particular semester.

Instructions: Complete this form and attach a cover letter to the Graduate Studies Committee that addresses the following information:

  • The reason for the LOA request
  • A list of the required courses in your plan of study you have already taken (this can be provided by attaching a copy of your current Advising Report)
  • An updated curriculum plan provided by your advisor that shows the semester/term of the remaining courses to be taken in your plan of study
  • Your proposed new date (semester/year) of graduation

Submit one copyof this completed form, cover letter, and supporting materials electronically as a single scanned PDFor MS Word document, with all supporting materials and signatures, to . The signatures of the advisor and SPD document awareness of the LOA request. Emails from the advisor and SPD may be substituted in place of physical signatures on this form.

Student Name______

Advisor Name______

Advisor Signature______

SPD Signature______

Last semester/term of enrollment (Month/Year) ______/____

Requested return for semester/term(Month/Year) ______/______

Graduate Studies Committee Use Only

______

Graduate Studies ChairDate

Notify: student, advisor, SPD and/or Director, Graduate Records Office

8/18