Leave of Absence Form

Leave of Absence Form
All students requesting a Leave of Absence (LOA) must complete this form after discussing their decision with the appropriate College administrator(s). If you are approved for a leave of absence, you are eligible to return without reapplication if within the approved time frame. Non-attendance does not constitute notification of intent to apply for leave of absence status.

The date of leave status is the date the Registrar receives this signed form. Complete all information requested; incomplete forms will not be accepted.
Student Information
Name*

First NameLast Name
Address*

Street Address

Unit, APT, Suit

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Student Information