DISTRIBUTION:
Registrar, Admissions, Division Dean, Financial Aid, Student
ACADEMIC LEAVE FORM
This form must be completed and filed before taking an academic leave of absence.
4.27 Academic Leave of Absence - Full-time matriculated students who must interrupt their program at the College for
reasons deemed acceptable to the vice president for academic affairs, may be granted an academic leave for a
specified period of time. Full-time students must have a minimum GPA of 2.00 and must have completed one or
more semesters to be considered for an academic leave of absence. Students may return to the campus following
the leave by contacting the Registrar’s Office to select classes.
Student Name: __________________________________________________ Student ID #: __________________
Major: __________________________________________________ Current GPA: __________________
Home Address: _________________________________________________________________________________
City: _________________________________ State: ___________ Zip Code: _____________________
I am requesting an academic leave of absence for:
Fall semester ________________ Spring semester _______________
Year Year
______________________________________
Student Signature
Position
Signature
Date
Approved
Denied
Advisor
Division Dean
Financial Aid
Vice President for Academic Affairs
State University of New York
College of Agriculture and Technology
Cobleskill, New York 12043
(May not be signed digitally.)
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