Academic Leave of Absence Form

(for Study Abroad or Internship students)

An undergraduate student whose enrollment at the University is interrupted for one or more semesters must make application for re-admission, unless an approved leave of absence has been granted. A leave of absence is granted for one semester only. If academic or disciplinary suspension occurs prior to the effective date of the leave, the leave of absence is automatically canceled.

Personal Information

First Name

Middle Initial

Last Name

Campus ID

Major(s)

Mailing Address

City

State

Zip Code

UWO E-mail Address

Leave Information

E-mail Address during leave

Semester on Leave of Absence

Spring
Fall

Year

Reason for Leave of Absence (Required)

If studying abroad, please include the name of the institution the program is through and what country you will be traveling to. If your absence is for an internship opportunity, please include the company name. If the internship is through the University, include the academic department name. College of Business students must contact Jessica Pondell at 424-3032 or pondellj@uwosh.edu. All others should contact Chrissy Lambie at 424-2044 or lambiec@uwosh.edu for written approval of internship.

Indicate Study Abroad or Internship

Study-Abroad
Internship

Do you receive financial aid (student loans, grants, scholarships)?

Yes
No

By checking this box, I verify that I have read the above information, understand it, and certify that the information provided by me is true. (Required)

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