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Current year in school?
Note: If in MD/PhD phase please contact your PhD administration. *
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Type of LOA:
Please note that all Medical LOAs require documentation from your treating health care physician to begin your leave and to return to PSOM. Please refer to the LOA Policy on the PSOM student website: https://www.med.upenn.edu/student/leave-of-absence-special-matriculation-short-term-break.html
All LOAs become a part of your permanent record, however the reason for the leave will not be specified. This will appear on your transcript and your Medical Student Performance Evaluation (MSPE). What type of LOA are you requesting? Descriptions of LOAs can be found on the PSOM student website: https://www.med.upenn.edu/student/leave-of-absence-special-matriculation-short-term-break.html *
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If Personal LOA Request, please describe:
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If your LOA request is for a Scholarly Leave Request, please describe:
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Estimated Start Date of LOA *
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Is this your first LOA? *
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Do you receive Financial Aid? This includes scholarships and/or any loans.
If yes, please contact the Director of Financial Services, Mike Sabara, to review tuition, fees and loan implications. *
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What is your current USMLE exam completion status? *
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Have you successfully completed the CSI exam? *
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