Name *

First Name

Last Name

Phone *

(###)

###

####

Program *

Cosmetology

Esthetics

Manicuring

Natural Hair

Start Date *

The first class date you will miss during this leave of absence.

MM

DD

YYYY

Return Date *

The date you plan to return to class. (Should be a day the school is normally open.)

MM

DD

YYYY

Reason for Absence *

Illness

Medical

Emergency

Other (explain below)

Do you have documentation? *

Some examples of documentation: doctor's notes, medical test results, court documents/letters, police reports, mechanic/garage invoices, obituaries, bills/shut-off notices, work schedules, flight/rental confirmations, letters from school. This is NOT a complete list, and acceptable documentation will vary based on the reason for the Leave of Absence.

Yes (Please email to the school with the subject "Leave of Absence Documentation.")

No (Please provide a full explanation above. We will contact you shortly.)

Acknowledgement *

I understand that regulations require that: - I am allowed to take multiple leaves of absence, - the total of all my leaves of absence may not exceed 180 days in any 12-month period, - I will not incur any additional tuition charges during any leave of absence, - in the event I do not return from a leave of absence, any refunds due will be made to the appropriate financial aid programs within 45 days of the date I was scheduled to return. For Federal loan borrowers: - If I do not return from my leave of absence, I understand that the period of my leave of absence will reduce my grace period.

Yes

No