Leave of Absence First Name Last Name Email Id Phone No Program Select ProgramCardiovascular TechnologistCertified Nurse AssistantDiagnostic Medical SonographyMedical AssistantMedical Billing & Coding SpecialistVascular TechnologistPatient Care Technician Reason for Leave of Absence Name of the current class/module Planning to complete current class yesno Anticipated Return Date I understand that although I am taking a Leave of Absence from the school I may still have a financial obligation to the school and that I am responsible for payment of any outstanding balances. E Signature Name Today’s Date
