Request for Leave of Absence

Request Form

Fill in the information below to request a leave of absence. Please allow two business days for an approval.

Student Number *

First Name *

Last Name *

Email Address *

Phone *

Address 1 *

Address 2

City *

State *

Postal Code *

Program of Study *

I am requesting a leave of absence for the following time period: *

30 days

60 days

I am requesting a leave of absence for the following time period: *

2 Weeks

4 Weeks

The faculty and staff at Lakewood College understand that sometimes life requires a student to take a temporary leave from their studies. If a student finds it neccessary to take a temporary reprieve from their studies they may request a leave of absence.

In order to request a leave of absence: (1) a student must be within their program completion date for the program, (2) a student must submit the request in writing prior to starting the leave of absence and (3) student's account must be paid in full or payments up to date and (4) the student must be in good academic standing to be eligible for a leave of absence. Failure to return from the leave of absence within the approved time may result in student dismissal.

For Veteran students the VA Office will be notified. Veteran students should contact their VA Office in the event VA Benefits may be affected.

Please indicate your reason for this request? *

I understand this application is not an official approval, but a request to have my account reviewed for qualification. I also understand that, if I am qualified and approved for a leave of absence, I will be sent an email confirmation within 3-5 business days. I understand if I do not meet all qualifications for an approval, I will be notified of such within 3-5 business days by a representative from Lakewood College for further options. *

Signed Name *

Date Submitted (MM/DD/YYYY) *