California State University, Long Beach
Enrollment Services
APPLICATION FOR EDUCATIONAL LEAVE
Matriculated undergraduate or graduate students, in good standing, who have completed at least one semester and have earned units at
CSULB may apply for an Educational Leave for a minimum of 1 semester or a maximum of 2 semesters. Additional leaves must be
requested by submitting a new Application for Educational Leave within University deadlines. Please note: while on educational leave,
students may not attend another CSU campus. CSULB students who want to attend classes at another CSU institution must meet the
eligibility criteria and submit the Concurrent and Visitor Enrollment Form to the Office of Enrollment Services. For information on enrolling
at another CSU campus through the Concurrent/Visitor program, visit the Enrollment Services website.
Applications for Educational Leave must be submitted to Enrollment Services, BH-101, by the last day of the previous Fall or Spring
semester. Applications submitted after the deadline will only be accepted through the last day of the requested semester and will be
assessed with a $10 missed deadline fee.
INSTRUCTIONS:
1. Complete the Educational Leave application form in full and obtain the required signature(s). VISA or Study Abroad Students
must also acquire approval from the Center for International Education, BH-201.
2. Drop all enrolled courses for the semester requested prior to submitting the Application for Educational Leave.
NOTE: Students who drop and receive ‘W’ grades do not need to apply for Educational Leave for that semester.
3. Submit the approved Application for Educational Leave in person at Enrollment Services, BH-101.
4. Change your graduation date if you file an application for educational leave for the semester you filed for graduation.
PLEASE PRINT ALL INFORMATION
Name: Campus ID #:
Class Level: Plan (Major) Program (Degree)
Certificate Objective:
Contact Information
Address:
City: Zip:
Telephone: H
ome Work/Cell/Message:
E-mail address:
Number
of Semester(s) of Leave: 1 2 Semester(s) and Year of Leave
I pla
n to return to the University: Fall Year: OR Spring Year:
Purpose
of Leave: Medical Personal Educational Other
Explanation: (Include all institutions you plan to attend during the planned leave and list courses you plan to take for academic credit)
Student Signature:
R
EQUIRED SIGNATURES OF APPROVAL:
UNDERGRADUATES - Major Department Chairperson
GRADUATES - G
raduate Advisor
Graduates attending another institution also need:
Major Department Chairperson Dean of College
□
VISA / STUDY ABROAD STUDENTS - Center for International Education, BH-201
Change of Graduation Date form submitted
