08/13
Leave of Absence Request Form
(To be completed by Student)
Student Name _____________________________________________ myWSU ID# _____________________
Program Information:
_____ Regular Program _____ Advanced Standing Program
_____ Full Time _____ Part Time
1. Briefly provide a rationale for your request for the leave of absence.
2. Explain when you plan to return and finish the MSW program.
3. Be aware that students are expected to return to the program one year from the semester the leave began.
Failure to request a leave of absence from the program and to register for the anticipated semester of return
to the program will result in the student being placed into nondegree admission status and would require that
the student reapply to the MSW program through the normal application processes if they wish to continue
their graduate studies. Students who are formally admitted into the MSW program but fail to register for
their first summer or fall semester coursework will be terminated from the program.
Student’s signature _______________________________________ Date __________________________
Adviser’s Approval (to be completed by MSW Adviser)
Approved
Approved, with the following changes:
Denied
Adviser’s signature _______________________________________ Date __________________________
MSW Director’s Approval (to be completed by MSW Program Director)
Approved
Approved, with the following changes:
Denied
Director’s signature _______________________________________ Date __________________________
