NOTIFICATION OF LEAVE OF ABSENCE

Please read carefully this important information about leaves of absence and speak to your Class Dean in advance of submitting this form.

* denotes a required field.

First name: * Last name: *
Banner ID: * Class: *

If you intend to take more than one type of leave (for example, a personal leave in the Fall and an international-study leave in the Spring) or if you will be studying on different programs or at different colleges in the Fall and the Spring, please complete a separate form for each semester.

Type of leave: *

If studying away please, specify program or host school:

Leave semester starting: *

If you are taking a leave for a semester already in progress, please indicate the date you will be leaving campus:

Return Semester: *

Are you a U.S. citizen or permanent resident? yes no