Request for Leave of Absence
Student name: _____________________________________________________ (Please type or print clearly) Current program (MS/PhD)/department: _______________________________ Date Leave of Absence to Begin:_________________Semester______________ Return to Program of Study date: _____________________________________ Reason for requesting leave of absence:__________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Plans for resuming and completing degree:_______________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Date of Request: ______________Student Signature: ___________________________ Major Professor Signature: ________________________________________________ Department Chair/Program Coordinator Signature: ____________________________ Dean, Graduate Education Signature: ________________________________________
If Leave of Absence is Granted: 1. Student will not be subject to continuing registration policy 2. Student will not have period of leave of absence counted in time limits 3. It will only be for the period of time granted in the leave of absence
GE8/07