Fillable Undergraduate Leave Of Absence Petition Form printable pdf download

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:

Name:

TUID:

Address:

Phone: ______________________________ Email:____________________________Major:__________________________

I request a Leave of Absence (LOA) for

one /

two semester(s):

Fall /

Spring _______ and

Fall /

Spring _______

year

Reason for Request:

Financial

Medical/Health

Personal

Military

Employment

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

forms.)

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:___________________________

Approved:_______Denied:_______Reason:______________________________________________________________

Dean’s Designee signature_____________________________________________ Date:_________________Email:___________________________

OFFICE USE ONLY:

OUR USE ONLY:

Database Updated:______________

Processed by:______________________

Sent to OUR:_____________ TUSafeSend to registration_our@temple.edu

Date:__________________

Notified Student:________________________

Notified Advisor: ____________________________

Undergraduate Leave Of Absence Petition Form

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