Leave of Absence Forms

What you need to do when you are unable to continue working.

Unfortunately, "things happen" and you may find yourself in a position where you will need to take a LOA – Leave of Absence.  If so, these two forms are required to be completed no more than 14 days after the leave has started.  Most LOA are planned; however, many are not.

ACGME requires the Sponsoring Institution to provide a written policy on satisfying the criteria for completion of the residency program.  Your Program Director will determine how your training requirement may be affected when taking a LOA.  You may not be eligible to take your boards until you satisfy your program requirements.

If an extension is required, you must get this in writing from your Program Director. 

U of M HR Request for Leave of Absence Form

UMHS GME Notification of House Officer Leave of Absence