Undergraduate Leave Of Absence Petition Form

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Undergraduate Leave Of Absence Petition
Leave of Absence (Undergraduate) Policy Number 02.10.16
To be effective for the current term, this petition must be submitted to your Advising office prior to the end of the second week of the semester.
Today’s date:
Phone: ______________________________ Email:____________________________Major:__________________________
I request a Leave of Absence (LOA) for
one /
two semester(s):
Fall /
Spring _______ and
Fall /
Spring _______
Reason for Request:
During my Leave of Absence I retain the following:
University requirements in place at the time of my first semester at Temple and the requirements for the Catalog year in which I declared
my program (major, minor or certificates).
Temple email access and library access/borrowing privileges.
Priority and self registration.
I understand that students granted LOA are not considered registered students and should be aware of the following consequences:
I am not eligible for any financial aid disbursements during the semesters while on LOA. Students on a LOA will be reported to lenders
and loan service agencies as “not enrolled” and will need to contact lenders for information on possible repayment requirements.
Enrollment verifications will be reported as “not enrolled,” which could affect my eligibility for health insurance, etc.
I am not eligible to use Student Health Services during the semester(s) while on LOA or any other University Services not listed in the
previous section.
I am not eligible for Campus Housing during my LOA.
I understand that I may return earlier than the return semester indicated by providing notice to the school/college as soon as possible, keeping in
mind applicable deadlines for registration, financial aid, etc.
I understand that if I do not return to the University following the approved term for my LOA and I later decide to continue my coursework at the
University, I will need to apply for re-enrollment and will be required to follow the college/major/minor requirements in effect at the time of my
return. The Undergraduate Request to Re-enroll to Temple University is submitted to the school/college where I plan to continue my education.
(Go to
for needed forms.)
I understand that if I originally left the University through the Withdrawal with Exception for Medical Reasons, I need to provide a Medical
Provider’s Statement to Return to the University before I register for classes. (Go to
for needed
NOTE: The Leave of Absence policy does not apply to those who have received permission to study at an institution other than Temple. Please see
an advisor if you are seeking permission to take courses elsewhere, whether in the U.S. or abroad.
I understand and agree to this policy:
Signature___________________________________________________________Date:_______________ Semester returning:_________________
Advisor’s signature___________________________________________________Date:_________________Email:___________________________
Dean’s Designee signature_____________________________________________ Date:_________________Email:___________________________
Database Updated:______________
Processed by:______________________
Sent to OUR:_____________ TUSafeSend to registration_our@temple.edu
Notified Student:________________________
Notified Advisor: ____________________________


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