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MLOA Forms


  • An MLOA provides you with the time to focus on your health and wellbeing and address the concerns that led to your decision to take a leave. It is expected that you will complete a course of treatment to address those concerns, and we recommend that you begin meeting with your providers immediately.
  • Treatment involves continuous engagement with a community medical and/or mental health provider until that provider determines the concerns that led to your leave have been adequately addressed and you could successfully return to the academic environment. While we do not make specific recommendations of length or frequency of treatment, regular engagement in treatment generally consists of more than a few sessions and must indicate progress towards treatment goals.
  • We recommend you share the MLOA Treatment Provider Report(s) with your provider at the beginning of treatment so that they are aware of criteria necessary to return to Vanderbilt.
  • While on an MLOA, you will NOT be eligible for student services, including the University Counseling Center, the Student Health Center, and the Center for Student Wellbeing.
  • If you have questions that come up during your leave, reach out to the Office of Student Care Coordination for support.
  • Should you wish to extend your MLOA, reach out to your academic dean’s office to request an extension.

MLOA Checklist

MLOA Treatment Provider Report

MLOA Release of Information Form

MLOA Student Success Plan

MLOA Leave of Absence SHIP Enrollment Form (NEW!)