Graduate Division / 200 West Kawili St. Hilo, HI 96720-4091 / COBE Building Room 201 / Phone: (808) 932-7927 / E-mail: hilograd@hawaii.edu
• Under exceptional situations, students may apply for a Leave of Absence.
• Students on leave are excused from the registration requirement during the period of the leave.
• A leave is normally granted for six months with a possible extension of six months for a total of up to one year.
• A leave of absence is granted only in exceptional circumstances, such as illness or other unusual personal hardship, and requires
detailed justification.
• A leave is not granted to students who wish to absent themselves to undertake thesis or dissertation research elsewhere.
• If possible, requests for leaves should be submitted one month prior to the semester for which the leave is requested.
• By completing this form, I understand that I may be required to re-apply with UH Hilo for future registration.
SECTION I: Student & Term Information:
Name: Student ID:
Email: @hawaii.edu Phone: Graduate Program:
Semester(s) of Leave: __________________________________ I Intend to Return in the FALL / SPRING of _________
Reason for Leave: Personal Previous Leave (if any): and
Maternity Term & Year Term & Year
Care for ill family member
Other:
Student Signature: Date:
SECTION II: Obtain Approving Signatures
Primary Advisor Name:
Primary Advisor Signature: Date:
Graduate Program Chair Name:
Graduate Program Chair Signature: Date:
Financial Aid: Date: I am not receiving Financial Aid
International Student Services: Date:
(For International Students Only)
SECTION III: Submit ORIGINAL completed form to the Graduate Division
Graduate Council Chair Name:
Graduate Council Chair Signature: Date:
Vice Chancellor for Academic Affairs Signature: Date:
GRAD DIVISION OFFICE USE ONLY: ☐ SPACMNT ☐ STAR ☐ SGASTDN Date: Initials:
REGISTRAR OFFICE USE ONLY: ☐ STAR Note ☐ SGASTDN Date: Initials: Rev. 05/2019
PETITION FOR LEAVE OF ABSENCE
