Free University Leave of Absence Form Template

University Leave of Absence Form

Please fill out this form completely to request a leave of absence from the university.

Student Information

Name

    Student ID

      Program of Study

        Phone number

          Email

            Leave Details

            Requested Start Date

              Expected Return Date

                Reason for Leave

                (please select one)

                  • Medical

                  • Personal

                  • Family

                  • Financial

                  Supporting Documentation

                  Please attach any relevant documentation to support your leave request (e.g., medical certificate, financial statement).

                  Acknowledgment

                  I understand that a leave of absence may impact my academic progress, financial aid, and other university benefits. I agree to communicate with my program coordinator regarding my return.

                  Name:

                  Date:

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