CHECKLIST FOR STUDENTS RETURNING FROM MEDICAL LEAVE
Dear Student: Use this form to keep track of the required documents for returning. For your use; do not
return to Messiah College.
_____ Letter from student sent to Engle Center
_____ Procured signed Release Forms A and B and given copies to provider(s) and Engle Center
_____ Provider Recommendation Form given to each mental health provider (provider is to return
completed form directly to Engle Center)
(List names of providers on each line)
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May, 2012