Fillable STUDENT IDENTIFICATION Semester and Year I will return (California State University, Los Angeles)

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STUDENT IDENTIFICATION Semester and Year I will return (California State University, Los Angeles)

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Leave of Absence Petition
Obtain appropriate approvals and submit this form to records@calstatela.edu at least one day prior to the start of
Office of the Registrar • SSB 1
st
Floor • 5151 State University Drive • Los Angeles, California
instruction for the term your leave of absence will begin. Petitions submitted after the published deadline will incur a $25
late fee and will only be accepted through Census. Students must drop their classes if enrolled for the term(s) of their
proposed leave. Students will be responsible for any grades and tuition charges incurred as a result of their classes not being
dropped prior to the start of the term.
STUDENT IDENTIFICATION
Send this form from your CalStateLA email address when submitting to records@calstatela.edu for processing.
CIN: Name:
Undergraduate students may request a leave for no fewer than 2 and no more than 4 semesters. Graduate students are granted a maximum of
2 semesters, subject to renewal. Continuing students’ allowed absence of 1 semester is included in these maximums.
Semester and Year I will return to Cal State LA
Fall Semester Spring Semester
2 0
I am requesting to extend an already approved leave
No Yes
CONTACT INFORMATION WHILE AWAY
I have updated my contact information in GET:
Home Address Mailing Address Home Phone Number Mobile Phone Number
I understand that Cal State LA will continue to communicate with me using my Campus Email address (…@calstatela.edu). While away, I will
monitor that inbox for important information.
REASON FOR LEAVE OF ABSENCE
My reason for requesting a leave of absence is:
Sending this form from your Cal State LA email address constitutes your electronic signature.
APPROVAL OF MAJOR ADVISOR, DEPARTMENT CHAIR, OR COLLEGE DEAN
Attach Major Advisor approval to your email when sending this completed form to records@calstatela.edu.
GRADUATE STUDENTS ONLY: APPROVAL OF COLLEGE GRADUATE DEAN
Attach College Graduate Dean approval to your email when sending this completed form to records@calstatela.edu.
INTERNATIONAL STUDENTS ONLY (F VISA): APPROVAL OF INTERNATIONAL STUDENT ADVISOR
Approval does not grant authorization to remain in U.S. See reverse side.
Attach International Student Advisor approval to your email when sending this completed form to records@calstatela.edu.
REGISTRAR’S OFFICE USE
Career Standing Last Enrolled Sem
Eligible Ineligible Processed by Date
Office of the Registrar • SSB 1
st
Floor • 5151 State University Drive • Los Angeles, California
Leave of Absence Petition
Obtain appropriate approvals and submit this form to the Records Office (records@calstatela.edu) at least one day prior to
the start of instruction for the term your leave of absence will begin. Petitions submitted after the published deadline will
incur a $25 late fee and will only be accepted through Census. Students must drop their classes if enrolled for the term(s) of
their proposed leave. Students will be responsible for any grades and tuition charges incurred as a result of their classes not
being dropped prior to the start of the term.
Leaves of Absence Regulation
University Catalog • Withdrawals and Leaves • Leaves of Absence
S
tudents may petition for a leave of absence for such reasons as:
• P
rofessional or academic opportunities, like travel or study abroad;
• Employment related to educational goals and major fields of study or participation in field study or research projects;
• Medical reasons, including pregnancy, major surgery, and other health-related circumstances; and
• Financial reasons, such as the necessity to work for a specified period to resume study with adequateresources.
Evaluation of petitions for leaves of absence takes into
account the student’s stated plans and the extent to which a leave would
contribute to educational objectives. Students are expected to plan their time of return and their activities during the leave. They
must also state why it is critical to remain in continuous residence. In the case of medical or financial leaves, they must state how
they plan to remain current with or advance in their academic field.
Undergraduate students may request a leave for no fewer than 2 and no more than 4 semesters. Graduate students are granted a
maximum of 2 semesters, subject to renewal. Continuing students’ allowed absence of 1 semester is included in these maximums.
Petitions must be emailed to the Records Office at records@calstatela.edu after action by the student’s major advisor (also the
college graduate dean in the case of graduate students) before the first day of instruction for the term during which the leave
commences. Approval entitles students to continuing status for registration purposes if they return no later than the semester
specified in their petition. Continuing students who return from a leave are not required to file an application for readmission.
Undergraduate students retain current catalog requirements for graduation; classified postbaccalaureate and graduate students
retain classified standing. Unclassified postbaccalaureate and conditionally classified graduate students who have an approved
program on file in their college graduate studies office are subject to the conditions of those programs. All others are subject to the
requirements in effect when they return.
Additional Eligibility Criteria:
• Student must have completed at least one semester in matriculated status (i.e. earned grades other than W or WU).
• Student may not be on Academic Disqualification at the time of petitioning.
International Students (F Visa):
International students in the United States for the sole purpose of education (F visa holder) are required to maintain full-time
enrollment each semester. Approval of a leave of absence request by the University does not waive this requirement. Therefore,
F visa students should request a leave of absence only if they plan to exit the United States during their time away from Cal State LA.
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STUDENT IDENTIFICATION Semester and Year I will return (California State University, Los Angeles)

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Completed 28 January 2022

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