96-129 Ala ‘Ike
Pearl City, HI 96782
University of Hawai‘i-West O‘ahu Phone: (808) 454-4700 or toll-free (866) 299-8656
Fax: (808) 453-6075
PETITION FOR LEAVE OF ABSENCE FORM info@uhwo.hawaii.edu
www.uhwo.hawaii.edu
Continuing classified students may be eligible to apply for a one semester leave of absence if they: (1) Have completed the prior semester at UH
West O‘ahu; and (2) Are not on academic action (e.g., academic suspension or dismissal). Eligible students are REQUIRED to meet with a Student
Services Advisor for approval. Incomplete, illegible and/or unsigned forms will not be processed.
The Leave of Absence form may be submitted either at the time of complete withdrawal from the University (should be submitted with the
Complete Withdrawal form) or by the last day of late registration for the semester that the leave is being requested.
________________________________________________ _______________________________________
Last Name First Name MI UH ID:
Clear Form
________________________________________________ ______________ ______________
Mailing Street Address Day Time Phone Home Phone
________________________________________________ ______________________________@hawaii.edu
City State Zip UH Email Address
Semester of leave of absence: Fall 20____ Spring 20____ Semester returning from leave of absence: Fall 20____ Spring 20____
Reason for leave of absence: ______________________________________________________________________________________
______________________________________________________________________________________
Leave of Absence Policies:
• This form is a request to petition for a leave of absence. A written notification will be mailed to the address above, which will inform me if my request has
been approved or not.
• I understand if my request is approved, I will be allowed to return the semester immediately following the approved leave of absence (summer excluded)
as a continuing student and may continue to follow the same general education, focus, major, concentration, residency, and university graduation
requirements that I was following at the time my leave of absence was approved.
• While on an approved leave of absence, I am responsible for contacting the Student Services Office for information regarding preregistration dates, tuition
payment deadlines, and all other pertinent information relating to registration.
• I understand that if I do not enroll in at least one course at UH West O‘ahu during the semester immediately following my approved leave of absence
(summer excluded), I will no longer be considered a student at UH West O‘ahu and must reapply for admission and pay all applicable fees by the
appropriate admission deadline. Furthermore, I will be subject to the catalog program requirements that are in effect at the time of readmission.
• I understand if my request is not approved, I must enroll in at least one course at UH West O‘ahu during the semester in which I intended to do a leave of
absence, otherwise, I will no longer be considered a student at UH West O‘ahu and must reapply for admission and pay all applicable fees by the
appropriate admission deadline. Furthermore, I will be subject to the catalog program requirements that are in effect at the time of readmission.
• Submitting this form or being approved for a leave of absence does not automatically drop my courses on the MyUH Portal or initiate the University’s
complete withdraw process; I am still responsible for dropping my courses or submitting a Complete Withdrawal form to the Student Services Office by
the appropriate published deadlines.
• I understand that if I decide to change my major/concentration upon returning from an approved leave of absence, I will be subject to the catalog program
requirements that are in effect at the time the Student Services Office receives the request to change my major/concentration.
• I understand that if I enroll at another college/university during my leave of absence, it may affect my transfer and/or overall grade point average at UH
West O‘ahu and may subject me to academic probation, suspension, or dismissal.
• I understand and am aware that taking a leave of absence may affect my eligibility for financial aid and residency status for tuition purposes.
• The effective date used to process this request is the date the Student Services Office receives this completed form.
I have read, understand, and agree with Leave of Absence policies stated above.
_____________________________________ ______________________________
Student’s Signature Date
OFFICE USE ONLY
Approved: YES NO ______________________________ WOALOA: _________
Catalog Year Following Upon Return
DB Track: __________
_____________________________________ ______________________________
Student Services Advisor’s Signature Date Ltr Sent: YES NO Date: ______________
REQUIRED SIGNATURE
Rev 08/2009