Leave of Absence Request
Note: Leave of absence requests must be completed by the student and approved by the Department Chair and Associate Dean for Academic Affairs. You will be notified of the outcome of your request via e-mail.

See the GSPHHP academic policies and academic calendar for more information.

Student Last Name:
Your answer
Student First Name:
Your answer
Student EMPL ID:
Your answer
Student E-mail Address:
Your answer
Student Phone Number:
Your answer
Student Concentration
Planned semester/year of leave:
Your answer
Planned semester/year of return:
Your answer
Planned semester/year of degree completion:
Your answer
Briefly include reason for leave below:
Your answer
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