Application for Temporary Leave of Absence

Use this form to request a temporary leave of absence from the PhD, DPT, or Research MA program.

Student Name(Required)
Leave of Absence is only available in the PhD, DPT, and Research MA programs.
Please provide details regarding why you are requesting a temporary leave from studies. Along with this form, please also provide additional supporting information relevant for your request (e.g., a note from your doctor or employer).
Please enter the start and end dates for the requested time away from the program. Leave time is granted in full term increments up to a maximum of three terms (i.e., one year).
Supervisory Committee Support(Required)