Fillable GRADUATE ACADEMIC LEAVE/WITHDRAWAL APPLICATION (State University of New York at Fredonia)

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GRADUATE ACADEMIC LEAVE/WITHDRAWAL APPLICATION (State University of New York at Fredonia)

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Use this form to apply for a leave of absence or to withdraw completely from your graduate degree program. A one or two semester leave of absence may
be granted for professional or personal reasons. A student may take, with her/his department's support, more than one leave of absence during her/his
program. Students who fail to return on time from a leave of absence, and those who withdraw completely, must apply for reinstatement.
An official leave of absence may be granted for medical reasons, deployment, or care of a family member. Please contact the Graduate Studies Office for
more details.
If you use this form to withdraw completely, you must complete the reinstatement form (http://www.fredonia.edu/gradstudies/forms.asp) should you decide
to return to your degree program. Contact the Graduate Studies Office with any questions.
GRADUATE ACADEMIC LEAVE/WITHDRAWAL
APPLICATION
Associate Vice President for Graduate Studies
http://www.fredonia.edu/GradStudies
(716) 673-3808
(716) 673-3712 (fax)
Graduate.Studies@fredonia.edu
SUNY Fredonia Graduate Studies
2142 Fenton Hall
Fredonia, NY 14063
I wish to apply for:
Fall Semester
Spring Semester
Reason:
(indicate year)
Department Chairperson
I approve the requested leave:
Copies:
Academic Dept.
Financial Aid
Graduate Studies Office
Student
File
If applying for a Graduate Academic Leave, please indicate the semester(s) you intend to be on leave:
(indicate year)
I support this application for leave of absence:
Advisor
Dean of the College of Education (if applicable)
Graduate Academic Leave
Withdrawal
I intend to return:
First Name Last Name Fredonia ID
Telephone NumberEmail Address
Permanent Address City State Zip
Degree Program
(indicate semester and year)
APPROVALS
Signature
Did not attend class
Last date you attended classes
Date
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GRADUATE ACADEMIC LEAVEWITHDRAWAL APPLICATION (State University of New York at Fredonia)

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Completed 1 February 2021

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