LEAVE OF ABSENCE
A Leave of Absence is available to students who are completing course work (excluding thesis, project, or capstone courses) and plan
to be inactive for a period of time not to exceed a full calendar year. Submission of this form provides a means for the Graduate
Studies Office to track a student’s progress and to term activate the student after the period of absence so he/she may register for the
upcoming semester. This form must be submitted one semester prior to the beginning of the Leave of Absence.
Students who have begun their final requirement and have an in-progress grade (“T”) may apply for a Leave of Absence only in the
case of extenuating circumstances. In such cases, this form must be accompanied by a letter to the Dean of the College and the
Director of Graduate Studies explaining the circumstances. Should leave be granted it will be for a semester at a time.
Date_______________________________
MSUB ID#____________________________________ Graduate Program _____________________________
Student Name: _____________________________________________________________________________________
Last First Middle
Address: __________________________________________________________________________________________
Street Apt # City ST Zip Code
E-Mail Address _____________________________________________ Telephone # ____________________________
Indicate the term(s) you are requesting Leave of Absence: Fall ______ Spring _________ Summer ________
Reason for leave:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
____________________________________________________________ ___________
Student Signature Date
ADVISOR Approve Do Not Approve
____________________________________________________________________________ ____________
Advisor Signature Date
DEPARMENT/UNIT CHAIR Approve Do Not Approve
____________________________________________________________________________ ____________
Chair Signature Date
REVIEWED BY:
_______________________________________________ ___________________________________________
Dean of College Director of Graduate Studies
2014-16 CATALOG
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
click to sign
signature
click to edit
![]()
