Childbirth and/or Planned Educational Leave Questionnaire Please fill out this questionnaire if you expect to take Childbirth Leave (as specified in the Graduate/Professional Student Childbirth & Family Leave Policy) or a Planned Educational Leave (as specified in the Planned Educational Leave Program) within the next 12 months. The information will be transmitted to the university facilitators who will contact you about subsequent steps. Last Name * First Name * Tulane email address * Tulane Student ID Number * Major/Field of Study * Name of Department/Program Advisor * Either your Director of Graduate Studies, Principal Investigator, or department/program graduate advisor. We will not contact them before we have reached out to you. Department/Program Advisor Email Address * What type of leave are you requesting? * Childbirth Leave Planned Educational Leave General purpose of your leave * Please give a general description of the reason you wish to take leave. You do not need to disclose private matters in this form; this is merely to help ensure your request is directed towards the appropriate parties. Have you spoken to your advisor about your leave? * Yes No Semester in Which You Will Go on Leave * - Select -Spring 2020Summer 2020Fall 2020Spring 2021Summer 2021Fall 2021 Semester in Which You Will Return from Leave * - Select -Spring 2020Summer 2020Fall 2020Spring 2021Summer 2021Fall 2021 For instance, if you are requesting leave for the entire Fall 2020 semester, please indicate Spring 2021. If your leave will last less than one full semester, or will cross semesters, please indicate the semester in which you expect to return to your studies. Have you registered for courses? * Yes No Have you registered for courses for the semester which will be impacted by your planned leave? Which courses are you enrolled in? * Have you paid registration fees/tuition? * Yes No Have you paid registration fees and/or tuition for the semester which will be impacted by your planned leave? Are you in research/dissertation? * Yes No Are you in the research/dissertation stage of your degree (for those students in PhD programs and some master's level programs)? Are you an international student? * Yes No Are you a student athlete? * Yes No Are you receiving financial aid? * Yes No Are you receiving a scholarship or loan to partially or fully fund your studies? This includes all aid except stipends and tuition waivers. If so, you will need to be in contact with your Financial Aid Officer to review any impact that taking a leave would have on your aid package. If you are uncertain who your Financial Aid Officer is, you can look them up at https://financialaid.tulane.edu/meet-us/staff.