GR Leave of Absence Form

Students may review the leave of absence policy here. To apply for a leave of absence, sudents must submit this form for approval. The leave should be requested prior to the beginning of the semester to be taken off, but exceptions may be made in the case of extenuating circumstances.

Please note the following:

Students who wish to take a leave of absence should contact the Financial Aid Office as aid may be impacted. Students should also contact Student and Department Account Services to make certain their account is settled prior to leaving the College.

Should your plans for returning change for any reason, you should inform the department chair and the Office of the Registrar.

If you have any questions, please call us at 503-768-6030 or email at gradreg@lclark.edu.

Today's date

First Name

Last Name

LC ID number

This is a 7-digit number.

LC Email Address

I have reviewed the LC Graduate School Leave of Absence Policy.

Yes

I have reviewed the LC Graduate School Tuition Refund Policy.

Yes

Term leave is effective

Term returning

Reason

Do you wish to drop your current classes?

YesNo

If you wish to drop your current classes, please provide your last day of attendance for each class.

Program

Be sure to check the whole list before making your selection, especially if you are in a program with MESOL/ESOL.

Department