Local Absence Form

Leave Request Form
I am submitting this request a minimum of 3 business days prior to my departure date. I understand that my request may be denied if not requested a minimum of 3 business days prior.
Full Name

First NameMiddle NameLast Name
ETA ID
Course
Site
Phone Number

Area CodePhone Number
E-mail
What type of leave are you requesting?

Short Term Leave

M1 International students - you can only request 2 days off per calendar week. This is based on Sevis Compliance Regulations. You must provide the address you will be staying below.
From:

MonthDayYear
To

MonthDayYear
Reason for Leave
Location and Contact Information
Contact Full Name

First NameLast Name
Phone Number

Area CodePhone Number
INTERNATIONAL STUDENTS ONLY Address you will be staying at during your leave.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Long Term Leave

This jotform must be completed and paired with all supporting documentation of a student Leave of Absence Request (LOA). A LOA may be required when a student is unable to attend school due to an external factor such as a medical issue affecting the student or immediate family member, military deployment, legal obligations (jury duty, court), or other factors that prevent the student from attending for an extended period of time. Students should refer to the school’s inactivity policy, LOA policy, and communicate with appropriate Epic staff to determine if they may qualify to apply for LOA.

While on an approved Leave of Absence, you may continue to request up to $2,500 per month in living expenses, subject to standard request procedures and deadlines. You acknowledge and understand that any funds disbursed during this period will reduce the total funds remaining for your flight training upon your return. Additionally, if you are unable to resume training within six (6) months from the start of your Leave of Absence, your student account will be closed, and you will no longer be eligible to receive living expense disbursements.

All requests for LOA must be accompanied by verifiable documentation to support the request as evidence of the student’s inability to attend school for a specified period of time. LOA requests require review of supporting documents by the Student Services Manager prior to approval or denial. If approved, the student must resume training by the anticipated return date, or may request an extension with the submission of updated documentation to support the leave. LOA may not exceed 180 days within any 12-month period. Failure to resume training following an approved LOA may result in dismissal. Failure to provide adequate documentation in support of the request may result in denial.
From:

MonthDayYear
To

MonthDayYear
Reason for Leave
Additional Information
Documentation must be attached to be approved

Browse Files

Cancelof
The Student Services Manager will review your request and notify you if it is approved or if additional information and/or documentation is required. You may not begin your leave until you have received official approval.

International students studying on an M-1 visa with an active Form I-20 are not permitted to take a long-term leave of absence while remaining in the United States.

If additional leave time is needed beyond the approved end date, you must submit a new request form along with updated supporting documentation for further review.

By signing I confirm all the information above to be accurate and true. I agree to have a working phone number that I can be contacted at during the entire time I am gone.
Should be Empty:

Leave Request Form