Please complete this form if you have returned from an LOA. You are also required to schedule a meeting with your Scholarly Concentration Director/s, within 30 days of your return to school, so you may review your remaining requirements. Name Original Class Year Current (New) Class Year Scholarly Concentration/Track - Select -Clinical Practice Innovation & EntrepreneurshipClinical & Translational ResearchCommunity/Urban HealthDisaster MedicineGlobal HealthHealth PolicyIntegrative MedicineMedical Education & LeadershipMedical Humanities Optional Comments Submit Leave this field blank