12/19 GS
GRADUATE LEAVE OF ABSENCE REQUEST
An admitted graduate student in good academic standing may request a leave of absence. A leave of absence:
• provides a guarantee that a student will be allowed to return to the graduate program at the agreed-upon time;
• exempts the student from the continuous enrollment requirement (applicable only to advanced doctoral students);
• does not constitute a waiver of the time limit for completion of a graduate program nor the one-year limit for completion of
a course.
A leave of absence is granted for a specific period of time, up to a maximum of three terms (excluding summer). Students may
request more than one leave of absence but all leaves combined cannot exceed six terms. A student with an approved leave of
absence cannot:
• register for any coursework;
• engage in any activities that require faculty time or use of University resources.
It is the student’s responsibility to drop or withdraw from all courses as well as notify other appropriate offices on campus of their
leave status (Financial Aid, etc.).
A completed leave of absence request must be submitted to the Graduate School no later than the Friday of the second week of the
term for which the leave should take effect. A leave of absence will not be approved retroactively.
Name ________________________________________________________________ PSU ID# _______________________________
Email (
PRINT CLEARLY) ____________________________________________________ Day phone _____________________________
Degree (MS, PhD, etc.) _______________________ Major ____________________________________________________________
Term(s) for which you are requesting leave: ________________________________________________________________________
Anticipated term you will return to your program: ___________________________________________________________________
Reason(s) for requesting a leave of absence:
(attach additional pages if necessary; your department may request documentation of extenuating circumstances)
Student signature __________________________________________________________________ Date ______________________
Recommendation:
Approve / Deny (circle one) _________________________________________________________ Date _______________________
Department Chair or Program Director
original signatures only; no stamps
Graduate School approval ___________________________________________________________ Date _______________________
Submit completed form to the Graduate School
184 Parkmill, 1633 SW Park Avenue ~~ grad@pdx.edu
