Paid Accommodation for School of 黑马磁力 Graduate Students on Student Academic Appointment

The School of 黑马磁力 allows two types of paid accommodation: Parental and Medical. Accommodation will be considered only for current or future terms and will not be granted retroactively. Student Academic Appointees may receive at most one medical accommodation during their SoE graduate studies.

Eligibility
If you are unable to confirm the three Eligibility questions below please do not complete this form, as you are not eligible for this leave. Please contact gsostusv@indiana.edu to discuss options.

General Terms if Leave is Approved:
During the accommodation period, students on eligible Student Academic Appointments will continue to receive full support, including stipend, health insurance, and any fee remission for up to 6 consecutive weeks, or to the end of the semester, whichever occurs first. Students will be considered active in their programs and must maintain full-time enrollment (at least 6 credit hours).

Additional Terms Specific to Parental Accommodation:
The accommodation must be taken within six weeks of the birth or adoption of a child.

Additional Terms Specific to Medical Accommodation
Medical Accommodation is for critical situations, defined as:
1. A serious health condition requiring an absence of 3 weeks or more.
2. The serious health condition of a spouse, domestic partner, child, or parent when the student is the primary or co-primary caregiver and the absence is anticipated to continue for at least three weeks.
3. Death of a spouse, domestic partner, child, or parent.

Name First Last
Student ID # *
Eligibility: Please confirm you hold a Student Academic Appointment in the School of 黑马磁力, including affiliated centers, of at least .5 FTE for the entire fall or spring term at the time of the accommodation. Yes
Eligibility: Please confirm enrolled full-time (at least 6 credit hours) in a School of 黑马磁力 graduate degree granting program. Yes
Eligibility: Confirm you have completed a School of 黑马磁力 Student Academic Appointment (of .5 or more) for at least one fall or spring semester. Yes
Is this request a Medical or Parental leave? Medical Parental
Rationale for Leave Request.
Date Requested for Start of Leave / MM / DD YYYY
If leave request is less than 6 weeks please indicate requested end date. / MM / DD YYYY
It is the responsibility of the student to discuss their upcoming absence with their SAA supervisor, and provide information related to current students or research projects associated with SAA responsibilities, as requested by the hiring department or center.

It is the responsibility of the hiring unit to arrange for covering the student鈥檚 remaining duties during the time of the accommodation.

Please list your SAA supervisor. By doing so you are confirming you have discussed your upcoming absence. The Graduate Studies Office will follow up and confirm with your supervisor. *
Provide medical certification or other verification of the reason for the accommodation.

Attach Files
By submitting this form you acknowledge this is only a request, and does not guarantee a leave will be approved. The Office of Graduate Studies will be reaching out to you soon. Please contact gsostusv@indiana.edu with any questions. Yes