{"id":693,"date":"2025-09-19T13:27:15","date_gmt":"2025-09-19T20:27:15","guid":{"rendered":"https:\/\/forms.bellevuecollege.edu\/imaging\/?page_id=693"},"modified":"2025-09-19T13:30:11","modified_gmt":"2025-09-19T20:30:11","slug":"rais-temporary-leave-of-absence-loa-or-withdrawal-request","status":"publish","type":"page","link":"https:\/\/forms.bellevuecollege.edu\/imaging\/rais-temporary-leave-of-absence-loa-or-withdrawal-request\/","title":{"rendered":"RAIS Temporary Leave of Absence (LOA) or Withdrawal Request"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_100' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_100'  action='\/imaging\/wp-json\/wp\/v2\/pages\/693' data-formid='100' novalidate>\n                        <div class='gform-body gform_body'><div id='gform_fields_100' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_100_1\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_1'><span class='gform-field-label__text'>ctcLink ID<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_1' id='input_100_1' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_100_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_100_3'>\n                            \n                            <span id='input_100_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_100_3_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_100_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_100_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_100_3_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_100_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                           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gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_5'><span class='gform-field-label__text'>Personal Email<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_5' id='input_100_5' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_100_6\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_6'><span class='gform-field-label__text'>Degree or Certificate<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_6' id='input_100_6' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Bachelors' >Bachelors<\/option><option value='Certificate' >Certificate<\/option><\/select><\/div><\/div><div id=\"field_100_7\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_7'><span class='gform-field-label__text'>Concentration<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_7' id='input_100_7' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Diagnostic Medical Sonography' >Diagnostic Medical Sonography<\/option><option value='Technology' >Technology<\/option><\/select><\/div><\/div><div id=\"field_100_8\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_8'><span class='gform-field-label__text'>Certificate<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_8' id='input_100_8' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Breast Ultrasound' >Breast Ultrasound<\/option><option value='CT' >CT<\/option><option value='Mammography' >Mammography<\/option><option value='MRI' >MRI<\/option><\/select><\/div><\/div><div id=\"field_100_9\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_9'><span class='gform-field-label__text'>Type of Leave<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_100_9'>Please select if you will be taking a Leave of Absence or Withdrawing from the Program.<\/div><div class='ginput_container ginput_container_select'><select name='input_9' id='input_100_9' class='large gfield_select'  aria-describedby=\"gfield_description_100_9\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Temporary Leave (2 quarters or less)' >Temporary Leave (2 quarters or less)<\/option><option value='Long Term Leave (more than 2 quarters)' >Long Term Leave (more than 2 quarters)<\/option><option value='Withdrawal (do not intend to return to the program)' >Withdrawal (do not intend to return to the program)<\/option><\/select><\/div><\/div><div id=\"field_100_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_11'><span class='gform-field-label__text'>Start of Leave<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_100_11'>Please provide the quarter you will be starting your leave or withdrawal (ie. Spring 2025)<\/div><div class='ginput_container ginput_container_text'><input name='input_11' id='input_100_11' type='text' value='' class='large'  aria-describedby=\"gfield_description_100_11\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_100_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_12'><span class='gform-field-label__text'>End of Leave<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_100_12'>Please provide the quarter you will be returning from leave (ie. Fall 2025). For temporary leave this cannot be longer than 2 quarters.<\/div><div class='ginput_container ginput_container_text'><input name='input_12' id='input_100_12' type='text' value='' class='large'  aria-describedby=\"gfield_description_100_12\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_100_13\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_13'><span class='gform-field-label__text'>Reason for Leave<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_13' id='input_100_13' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Academic' >Academic<\/option><option value='Career' >Career<\/option><option value='Financial' >Financial<\/option><option value='Personal\/Family' >Personal\/Family<\/option><option value='Medical\/Health' >Medical\/Health<\/option><option value='Military Assignment' >Military Assignment<\/option><option value='Transferring to another college\/university' >Transferring to another college\/university<\/option><option value='Relocation\/Moving' >Relocation\/Moving<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_100_15\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_15'><span class='gform-field-label__text'>Additional Information or Comments<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_15' id='input_100_15' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_100_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_100_14'><span class='gform-field-label__text'>Electronic Signature<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_100_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_100_16\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker 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