Student Readiness to Return Form

Calvin University wants to ensure that students can successfully return from a Health Leave of Absence (either voluntary or involuntary). To support this process, students who wish to return must demonstrate they are able to safely resume their program, will not be disruptive to the community, and are well enough to carry out substantial self-care obligations and participate meaningfully in educational activities (with or without reasonable accommodations arranged through the office of Disability Services). Completion of the student’s Health Leave Plan will be considered in evaluating readiness to return.


Students can initiate a return from Health Leave by following these three steps:

  1. Complete the Reflective Statement form below
  2. Request that all current treatment providers complete the Readiness to Return Provider form (following any instructions their offices provide regarding consent to release information)
  3. Request a meeting with the Dean of Students

All information submitted via this Reflective Statement Form will be reviewed by University personnel (Dean of Students, Chair of the CARE Team, or another designated representative) for review, and further information may be requested to determine whether the issues that previously established criteria for a Health Leave have been sufficiently addressed. The Dean of Students will notify the student in writing of the decision regarding return to the university. Students not permitted to return may appeal the decision to the Vice President for Student Life.


Students approved to return from Health Leave will subsequently complete a readmission application through the Admissions Office and also work with the Dean of Students to develop a supportive return plan. A Leave Coordinator will be available to help coordinate a successful return.


The full Health Leave of Absence Policy for Calvin University can be found at: 

Health Leave Of Absence & Return Policy - Policies | Calvin University

Personal information









Student Information





Treatment & Supports

Treatment Provider(s) – Please list information pertaining to any healthcare professional(s) who provided care for you during Health Leave.


















Support System - Please identify at least one person who served as a primary support system for you during your leave.
















Questions


Please provide thoughtful, reflective personal responses to the following questions. There is no length requirement for your response. It is important that you share all information you believe is necessary for us to gain a complete understanding of your wellness and readiness to return to Calvin.