PSR Leave of Absence Request

PACIFIC SCHOOL OF RELIGION

REQUEST FOR A LEAVE OF ABSENCE

This request must be filed in the Office of Academic Affairs before the end of the registration period of the semester for which the leave is being requested. Filing after the end of registration may incur a $100 late fee. If a student does not register for a semester and does not request a leave for that semester, they may be terminated as an active student and may need to contact the Admissions Office to apply for re-admission in full. A maximum of two semesters of leave can be requested at one time.

GTU Master of Arts (MA) students should not use this form; they should use the GTU Leave of Absence form and may be charged a Leave of Absence fee if application is approved.

Please note that all leaves of absence are included in the applicable lapsed-time period for the completion of programs at PSR. For more information please consult the Academic Catalog.

Student Information *This question is required.

Name

Email This question requires a valid email address.

Mailing Address during leave period:

City, State, Zip

Phone

Advisor Name

Advisor Email This question requires a valid email address.

Program Information and Plans to Return

I started the program:

in semester/year:

I request a leave of absence for the following semester(s) and year(s):

I plan to re-enroll in (sem/yr):

The purpose of the leave:

*This question is required.

The proposed outcome of my program at PSR (include a projected graduation date, if possible): *This question is required.

I have discussed my leave plans with my advisor, and my advisor is aware of my plans. *This question is required.

I verify the above is correct