General Leave Of Absence Request


General Leave of Absence Request
Office of the Registrar
101 Bresee Hall
Hartwick College
Oneonta, NY 13820
Tel: 607-431-4460; Fax: 607-431-4260
To begin the process of taking a leave of absence from Hartwick College, you must complete this form and return
it to the Office of the Registrar. The form may be dropped off, mailed, or faxed. You are required to complete a
‘Return from General Leave of Absence Request’ at least 10 days prior to the start of the term you intend to
return. This form cannot be used to process a medical leave of absence.
ID No:
Graduation Date:___________________
Submit Date:
Please check the following to indicate type and date of leave you are requesting:
General Leave
Start Date:
End Date:
J-Term Leave
Reason for leave of absence (please print):
Prior to submitting this request, please follow the procedures below and check items as completed:
Consult with and inform your parent or guardian of your intent to take a leave of absence;
Work out your complete academic program with your advisor to assure that you will be able to satisfy the distribution
and major requirements for a degree upon your return;
Determine the effect a leave will have on your financial aid, if you receive any from Hartwick College, by contacting
the Office of Financial Aid.
I certify that the above information is accurate and the above steps have been completed. By signing this form I
also understand that in order to return from a leave of absence I must complete a ‘Request to Return from a Leave
of Absence’ form.
Student’s Signature
Registrar Signature
Office Use Only (R5)
____Approved ____Denied _______Date Processed ______Processed By


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