Leave of Absence Request
(Policy and Procedure Statements Appear on Reverse)
Name: Last
UPS ID #: First
MI
I would like my registration materials mailed to:
Phone: (
) Street Address
City
State
If the address above is not your permanent address, may we use your permanent address as an alternative?
E-mail: ZIP
m Yes m No
(Note: Your Puget Sound e-mail account remains active while you are on leave.)
Class Standing: FR______ SO______ JR______ SR______
Advisor’s Name: Choose One:
____ I am registered for the coming term.
____ I will withdraw my registration for the coming term.
Leave to Begin: (This is the first term you will be on leave.)
Leave to End: (This is the first term you plan to be re-enrolled.)
____ I did not register for the coming term.
Check your reason(s) for requesting a leave of absence:
____ Transferring schools/Major or program not offered/
Desired classes not offered
____ Need a break/Need time to decide what to do
____ Financial issues
____ Other (specify): ____ Medical leave/Illness
____ UPS is not a good fit for me/Social reasons
____ Employment
____ Traveling/Nonaffiliated academic program
____ Family reasons
____ Academic Difficulties
Check all that apply:
____ I am an undergraduate student at the university.
____ I have not been suspended or dismissed from the university.
____ I have filed an application to graduate with the degree evaluator.
____ I plan to attend another college or university while on leave (see Procedure 3 on reverse).
Where? Note: The leave of absence policy requires that you be interviewed by a staff member of academic advising. Please take a few minutes for this interview while
in the office. (You may schedule this interview by calling 253.879.3250.) If you have questions, send an e-mail message to jkiefer@ups.edu.
Student’s Signature: Date: Comments:
Interviewed by: Date: Leave of Absence Policy
The leave of absence is intended to provide a short-term leave, not to exceed two calendar years, for students who plan to return to
Puget Sound. Please NOTE: If you plan to study abroad, visit the Office of International Programs in Howarth 215.
An undergraduate student who has completed at least one full term at Puget Sound and has not been suspended or dismissed for
academic reasons may apply for a leave of absence. A student may be granted a leave either during a term or anytime before classes
commence in the semester following the last term attended.
A student who obtains a leave of absence during the first eight weeks of the term will be eligible for tuition adjustment in accordance
with the published university tuition adjustment schedule. Additionally, financial aid awards made to students who withdraw from
courses are subject to reevaluation based on changes to tuition, fees, particular award requirements, and possible federal aid refund
requirements. Student Financial Services will contact each withdrawing student to summarize the financial impact of the withdrawal.
Any balance due remaining on the account must be paid within 30 days of the withdrawal.
In addition to any other conditions or responsibilities as set forth in the application for leave or notice of approval, the student will
be expected to keep the Office of Academic Advising apprised of his/her mailing address and to meet all regular university deadlines
with respect to registration, housing reservations, financial aid application, and similar matters. Students should be advised that
scholarship awards or financial aid will not necessarily carry over, nor will places with university housing necessarily be held.
Students on leave are responsible for all arrangements with offices (Student Financial Services, Residence Life) serving them in
these matters. They are also responsible for giving at least one month’s notice of intent to re-enroll to the Office of Academic Advising
in order that a registration appointment and other reasonable services may be provided.
If the student attends another college while on leave, official transcripts must be sent to the Office of the Registrar for the purpose of
evaluating academic standing and credits according to regular transfer policy.
Procedure
A. Obtain a leave of absence request form from the Office of Academic Advising.
B. Fill in the appropriate blanks on the form.
1. Use the address to which university correspondence should be directed. If you do not yet know what your address will be, fill
in your permanent address. Please provide us with your address as soon as possible.
2. Leave to Begin/Leave to End:
a. If you are leaving during a term, note the coming term as the beginning of the leave.
b. If you are withdrawing at the end of the current term and you have already registered for the coming term, you must drop
your classes before your leave of absence can be posted.
c. You may take up to two years on the leave of absence program. Regardless of what you have stated as your “leave to end”
date, we will watch for your return each term and at the end of two years will cancel your leave of absence if you have not
returned.
C. If you plan to enroll in another college or university during your leave, consult with your academic advisor about possible course
selections. If you hope to take courses that might satisfy core requirements or major requirements, you should see the transfer
evaluator in the Office of the Registrar for assistance. If appropriate, the evaluator will issue a form to you which certifies in advance that the courses you will take will be accepted at Puget Sound if necessary conditions are met.
D. Alert Regarding Financial Aid: If you are receiving any financial aid from the university or loans from a private lender (bank, credit
union) for educational purposes, you must personally contact Student Financial Services. If you are receiving any special scholarships or grants based on performance (music, athletics, etc.), it is your responsibility to contact the appropriate department about
possible renewal when you return and to notify Student Financial Services about that agreement or understanding.
Rev. 02/08