Leave of Absence Request and Authorization Form

A student in good academic and financial standing may request a leave for one or two semesters.  A leave begins at the end of a regular semester

The student is expected to return at the conclusion of the leave or to request an extension of the leave. 

To be granted a leave of absence a student must:
  • Set up a meeting to discuss financial implications with a representative of Student Financial Services
  • International students on F-1 status should set up a meeting with staff at McCulloch Center for Global Initiatives regarding student visa implications
  • Complete and submit this form.
Correspondence from Mount Holyoke College will be through your Mount Holyoke email address or by mail to the last permanent address noted on your student record.

Students who take a leave without a formal request or notifying the college through this form will be withdrawn from the college and must request reinstatement if they wish to return.
 
Today's Date
Today's Date
Birthdate
Birthdate
Last Year and Term of Attendance:
Year and Term of Expected Return:
(limit of two semesters of leave of absence during the pursuit of the graduate degree)
Reason(s) for Leave:
Effective Date
Effective Date

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