Medical Leave of Absence – “To-Do” Checklist
- Review the full Medical Leave of Absence process on the Dean of Students’ website: https://go.geneseo.edu/mloa
- Complete the MLOA request form. The form defines the MLOA and has a small section for student completion on the last page.
- Fill out this Health & Counseling center MLOA Authorization for Release of Information indicating that your provider can release information to H&C, and H&C can release information to the Dean of Students and your provider. To avoid confusion, complete the form twice - once authorizing correspondence between your provider and Lauderdale, and the second between Lauderdale and the Dean of Students.
- Have your provider send documentation on professional letterhead supporting your request for an MLOA to the Health & Counseling Office, including the following information:
- the reason the medical leave is recommended (including statement of impact on current functioning);
- relevant diagnoses;
- date of initial treatment;
- dates of subsequent treatment (if applicable); and
- plans for anticipated treatment while separated from the College.
The Health and Counseling office reviews the documentation and shares it with the Dean of Students. The Dean of Students then determines whether or not to grant the medical leave of absence.
- Complete the standard Leave of Absence request form.
- When the time is right, and if the MLOA is approved, to document your ability to return to Geneseo at the end of your medical leave, your provider will fill out either the: Return from MLOA, Mental Health Care Provider Form or the Return from MLOA, Health Care Provider Form, depending on your reasons for leaving.
There are deadlines to request returns (e.g., the first week in January or August), but you can request a return in advance of that, with your provider’s support, to allow you to register for classes for the semester of your return (your time ticket depends upon your return being cleared by the DOS). The Dean of Academic Planning and Advising office can also assist students with registration if Geneseo needs to wait to approve returns.
All materials can be emailed to email@example.com or mailed to the Dean of Students at the College via the following address:
Dr. Lenny Sancilio SUNY Geneseo 1 College Circle Geneseo, NY 14454