Saint Louis University
Petition for Leave of Absence
Form
#4
Updated 03/2016
Office of the University Registrar - DuBourg Hall, Room 22
One Grand Blvd. St. Louis MO 63103 314.977.2269 registrar@slu.edu
Section 3
Student Justification
State in clear, concise sentences why a Leave of Absence is being requested. Please attach any
additional documentation.
Section 2
Period of Leave
Semester to begin Leave (fall/spring/summer and year)
Semester to Return (fall/spring/summer and year)
A leave of absence may only be requested for future terms.
If withdrawing from the current term after the add/drop
period, please complete the Petition for Semester
Withdrawal and enter the next semester above.
No later than one year from the beginning of the leave.
Student Name
Student Email
Primary Program/Major
Student ID
Student Phone #
Total Earned Hours
Saint Louis University
Petition for Leave of Absence
Form
#4
Office of the University Registrar - DuBourg Hall, Room 22
One Grand Blvd. St. Louis MO 63103 314.977.2269 registrar@slu.edu
I understand and acknowledge that:
A leave of absence may not be longer than one calendar year.
During the leave of absence, students:
retain the graduation requirements of the Undergraduate Catalog of their year of admission,
do not have enrollment status for purposes of health insurance or federal loan deferment,
are not eligible to reside on campus, attend classes or participate in extracurricular campus
activities and
retain their SLU email account, access to mySLU.slu.edu and access to the libraries.
Unless approved, students attending another institution will have their leave of absence
revoked and therefore will be required to reapply to Saint Louis University in order to return.
Undergraduate students must complete a Scholarship Deferment Form from Student Financial
Services to determine if SLU aid will continue upon return. For questions please contact the
office at 314-977-2350 or stop by DuBourg Hall, Rm 121.
International students must consult with the Office of International Services concerning
conditions of their student visas.
Student Signature
Date
Section 4
Acknowledgements
1.
Student completes sections 1, 2 and 3.
2.
Student acknowledges policies related to a leave of absence by signing in section 4.
3.
Student meets with Advisor (Undergraduate) or Department (Graduate) to discuss petition and
receives approval via signature in section 5.
4.
Advisor/Department submits petition to their College/School/Center for Dean/Director approval.
5.
College/School/Center submits approved petition to the Office of the University Registrar.
6.
College/School/Center notifies student of approval.
7.
Office of the University Registrar records the approved Leave of Absence on the student’s record.
Form Procedures
Section 5
Approvals
Advisor/Department Name Signature
Date
Dean/Director Name Signature
Date
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signature
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signature
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signature
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