Request For Leave Of Absence

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Newcomb-Tulane College
REQUEST FOR LEAVE OF ABSENCE
Name:
SID:
Class: FR
SO
JR
SR
Email:
Local Address:
Telephone:
Permanent Address:
Telephone:
Major:
Degree:
I am requesting a leave of absence for:
(#) semester(s) (1 or 2).
I expect to return to Tulane for the
Fall
Spring
Summer
semester in 20
.
Reason for Requesting a Leave of Absence:
Medical
Personal
Study Away (in the United States)
Study Abroad
Institution:
Program:
Has this program been approved by the Center for International Studies? Yes
No
I have read and understand the policies and procedures described above.
Student’s Signature:
Date:
OFFICE ACTION: Most Recent Term Enrolled
Cum GPA:
Advisor’s/Dean’s Signature:
Date:
Approval for this leave is subject to the student meeting continuation standards at the close of the semester
before the leave begins.
Fax to Financial Aid (x 8750)
Center for Academic Advising ▪▪▪▪ 102 Richardson Building ▪▪▪▪ Newcomb-Tulane College ▪▪▪▪
Phone: 1-504-865-5798
Fax: 1-504-865-5799
Academic Advisor’s Initials:___________________
REV 12/10 ATO

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