Application For Military Leave Form
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1California State University, Long Beach
Enrollment Services
APPLICATION FOR MILITARY LEAVE
MILITARY LEAVE ELIGIBILITY REQUIREMENTS:
As provided for in the Higher Education Opportunity Act of 2008, students will be granted a Military Leave to serve in the
Armed Forces of the United States based on the following provisions:
Absence is due to active duty service in the Armed Forces, including the National Guard or Reserves, for
more than 30 days.
o
The service member or veteran provides the CSULB
Veterans Affairs Services Office
with advance
notice that the need for a leave of absence is due to military service
o
Students must submit the Application for Military Leave to CSULB Veterans Affairs Services Office
The cumulative length of all absences for service in the uniformed services may not exceed five years. This
period includes only the time spent actually performing service, not the period before reporting for duty and
the time between completing service and returning to the institution.
:
INSTRUCTIONS
1. Withdraw from all enrolled courses for the semester requested prior to submitting this form
2. Submit this form to the Veterans Affairs Services Office, Foundation Bldg., Rm 265
PLEASE PRINT ALL INFORMATION
Name:
Campus ID #
____________________________________________________
: ____________________
Military Plans:
I plan to enter the military on:
___________________
___________
_____________
Month
Day
Year
My expected separation from the military is:
___________________
___________
_____________
Month
Day
Year
I plan to return to CSULB on:
______________________
________________________
Fall/Term
Spring/Term
Additional Information
:
______________________________________________________________________________________________________
_______________________________________________________________________________________________________
Student Signature: _____________________________________________________
Please note: If your military plans change, please contact the Veterans Affairs Services Office
REQUIRED SIGNATURE OF APPROVAL
____________________________________ Date _______________________
Veterans Affairs Services Office:
For Enrollment Services Office ONLY:
st
nd
1
Semester/Year __________ 2
Semester/Year _________
rd
th
3
Semester/Year _________ 4
Semester/Year __________
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