Registry Leave of Absence Please review the full policy at this link: Click here Please read the full policy. Types of leave may include those as are commonly defined within provincial and federal laws governing employment LOA’s. These may include medical leave, work interruption (employment change/ disruption), military service, civic responsibility (i.e. jury duty) and compassionate leave (family care responsibility; bereavement). Maternity and paternity leave does not constitute a leave from practicing status. Following an employment maternity/paternity leave, a College registrant can apply for up to 6 months’ time of extension for submission of CEU’s. There will be no fee assessed for this requested CEU extension request due to a maternity employment leave. Request for extension must be received 15 days prior to the CEU submission dates. Approved LOA’s do not change the date or requirements for annual registration maintenance. Name* First Last Home Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Phone* Fax Personal Email* Employer Information Employer Name* Employer Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Work Phone* Work Fax Work Email* Position Title* Request Date of Leave* Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 End Date of Leave (max. 12 months)* Month123456789101112 Day12345678910111213141516171819202122232425262728293031 Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Type of Leave of Absence Requested Health Reasons (Please attach Medical documentation) Military Employment Change/interruption Jury Duty Bereavement Return to School Other (describe below) Other Please enter other reason for Requested Leave of Absence Current Designation CVRP CVRP(F) CVRP(D) CVRP(P) CCVE CCVE(F) CCVE(D) Registration Number* Year Certified and Registered* If also a CCVE, please note Year Certified Length you have held valid certification (YEARS) Leave of Absence Application Fee (non-refundable): $75.00 + HST or GST (based on Province of Residence) Price: $ 75.00 CAD Application Fee ( There is an administration fee of $15.00 plus HST for manual submission, cheque and money orders)* Cheque/Money Order made payable to CVRP Online PayPal Total $ 0.00 CAD Application Declaration:* By checking here I understand that I must notify the College before I return to ANY active VR employment as I must activate my registration status to Practicing. By checking here I understand that at it is a act of Professional Misconduct to work as a CVRP while registered as Leave of Absence status. Application Declaration:* By checking here, I agree to all the terms and conditions outline by CVRP in this application. I hereby verify that the information submitted for this application accurately documents my request without impinging on my right to Privacy. I understand that providing false information will result in immediate withdrawal of my application and could result in disciplinary action. I understand that I must have current E&O insurance coverage and will maintain that coverage through-out my LOA. I hereby declare that the information given in this application is, to the best of my knowledge, true, correct, and complete in every aspect and that I am the applicant.