Fillable GS-LoA Request for Leave of Absence Instructions for (Clemson University)

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GS-LoA Request for Leave of Absence Instructions for (Clemson University)

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Current Graduate School forms reside at https://www.clemson.edu/graduate/students/forms.html Form GS-LoA — Request for Leave of Absence Rev. 07/2020
CLEMSON UNIVERSITY GRADUATE SCHOOL E-106 Martin Hall Clemson, SC 29634-5713 ph. 864.656.5202 page 1 of 3
GS-LoA — Request for Leave of Absence
Instructions for Completing the GS-LoA
Purpose of this form
: Degree-seeking graduate students will use Form GS-LoA to request an official leave of
absence from studies for compelling personal, family, medical, or professional reasons.
Time frame: The completed GS-LoA form must be submitted by the last registration day for the initial term of
absence. The student’s account will be deactivated if the student is not enrolled or on approved leave.
Before completing Form GS-LoA, please read the Graduate School’s policies and procedures pertaining to Leave of
Absence, Continuous Enrollment, and Readmission. These topics are searchable and listed in the table of contents of the
Graduate School Policies & Procedures Handbook, available online as a PDF at
http://www.clemson.edu/graduate/students/policies-procedures/index.html.
How to use this form: This form is designed to be completed onscreen and transmitted electronically as a PDF,
forwarded to signees and digitally signed by all designated parties, and submitted to the Graduate School as an email
attachment. It may also be completed and delivered by the alternative methods described below.
• For all-electronic submission: Once you have completed your portion of this form, attach it to an email to your
academic advisor. Ask your advisor to sign and forward to your department chair. Your department chair should
sign and return to you (if you are a domestic student) or to International Services at is@clemson.edu (if you are
an international student—a leave of absence may affect your visa status). The last signer should return the form
to you.
Once you have obtained all the necessary signatures from your advisor and/or program coordinator, email
the form to the Graduate School at:
GS-LoA-form@lists.clemson.edu
• For electronic completion with paper submission: You may print and complete the form by hand, obtain
signatures from all designated parties, and then scan the form and send it as an email attachment to:
GS-LoA-form@lists.clemson.edu
• For all-paper submission: You may print and complete the form by hand, obtain signatures from all designated
parties, and then deliver the form as hard copy to the Graduate School at this address:
The Graduate School
Clemson University
E-106 Martin Hall
Clemson, SC 29634-5713
Current Graduate School forms reside at https://www.clemson.edu/graduate/students/forms.html Form GS-LoA — Request for Leave of Absence Rev. 07/2020
CLEMSON UNIVERSITY GRADUATE SCHOOL E-106 Martin Hall Clemson, SC 29634-5713 ph. 864.656.5202 page 2 of 3
GS-LoA — Request for Leave of Absence
This form must be completed and submitted by the last registration day for the initial term of absence. Your student account will
be deactivated if you are not enrolled or on approved leave. Return completed form to The Graduate School, E-106 Martin Hall,
according to instructions on previous page or email to GS-LoA-form@lists.clemson.edu.
Name: Cell phone:
Email: XID#:
£
Domestic
£
International student
£
Master’s/Specialist’s
£
PhD Program
Address while on leave:
Street / city / state / country
Term(s) of requested leave:
FROM
£
Spring
£
Summer
£
Fall TO (returning term)
£
Spring
£
Summer
£
Fall
year year
Month/day leave starts, if known:
Reason for requesting leave:
"
Medical leave (please attach documentation)
"
Other (please describe on next page)
£
I have discussed my financial support for my return with my program coordinator. I understand that my financial support
(assistantship, traineeship, fellowship):
"
will be available upon my return;
"
will not be available upon my return;
"
I do not have financial support from the department or program.
£
I have discussed my intended leave of absence with my advisor and/or program coordinator, and (if I am an international
student holding an F-1 or J-1 visa) with an International Services advisor, as indicated by the signature(s) below.
£
I have at least a 3.0 GPA and have passed/completed all program requirements to date (comps, qualifiers, etc.).
£
I understand that while I am on leave, I may not utilize Clemson University resources including laboratory facilities, recreation,
or health and wellness facilities.
£
I have read the Leave of Absence, the Continuous Enrollment, and the Readmission policies in the Graduate School Policies &
Procedures Handbook. I understand the consequences of failure to adhere to these Graduate School requirements.
Signature of student Date
Advisor (print name) Signature Date
Program Coordinator (print name) Signature Date
International Services Advisor (print name, if applicable) Signature Date
To be notified by email after approval:
Department Head (print name and email)
GRADUATE SCHOOL ACTION:
£
Leave approved
£
Leave not approved
Comments:
Graduate School Dean signature Date
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Current Graduate School forms reside at https://www.clemson.edu/graduate/students/forms.html Form GS-LoA — Request for Leave of Absence Rev. 07/2020
CLEMSON UNIVERSITY GRADUATE SCHOOL E-106 Martin Hall Clemson, SC 29634-5713 ph. 864.656.5202 page 3 of 3
GS-LoA — Request for Leave of Absence (continued)
Explanation for requesting leave (continued from previous page):
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GS-LoA Request for Leave of Absence Instructions for (Clemson University)

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Completed 19 August 2020

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