General Leave Of Absence Request printable pdf download

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.

Name:

ID No:

Advisor:________________________________________________

Graduation Date:___________________

Phone#/Email:

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

Year:

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

Date

Registrar Signature

Date

Office Use Only (R5)

____Approved ____Denied _______Date Processed ______Processed By

Comments:

General Leave Of Absence Request