Office of the Registrar

Leave of Absence

 Instructions - Please click here to read the instructions on taking a Leave of Absence.

Name: WID: Today's Date:
Credits earned to date: Credits in Progress:
Start Year at Whitman:
Major (if declared): Adviser:

If taking a LOA during the semester, what was the last date you attended class?

When would you like the leave of absence to begin?
 Fall Semester Spring Semester Other (specify)

For how many semesters are you requesting a leave of absence?
 One Semester Two Semesters Other (specify)

Why are you taking a leave of absence from Whitman College?
(check all that apply)
Foreign Study Programª Personalb Travelb Workb Healthb
Otherb Major/Programc Special Programc Another Collegec Financiald

Explanation for leave:

During your LOA, do you plan to attend another College or University?
Yes No   If yes, where?

Address During Leave City
State/Zip   Phone Number During Leave
E-mail During Leave

___________________________

   _____________________________

Student’s Signature/Date

    Adviser's Signature/Date


Please return this completed form to the Registrar's Office

Recommendation by the
Dean of Students 		Board of Review

Approved

Approved Board of Review

Not Approved

Not approved Board of Review

_____________________________

______________________________

Dean of Students' Signature/Date

Board of Review/Date