_______________________________ ______________________
Name: Date of this request
Date admitted to the program
I hereby request a leave from the School Improvement program at the University of West Georgia
for the following reason:
I accept the responsibility for submitting in writing a request for a readmission interview with the
Program director in order to determine my readiness for readmission to the program. This request
must be made by at least 60 days prior to semester of proposed reentry.
I understand that I must be in academic and professional good standing at the time of my request
and that I will be assigned to the next available cohort on a space available basis.
______ Approved ______ Denied
Student Signature
Program Director Signature Date
01/16
DOCTOR OF EDUCATION in SCHOOL IMPROVEMENT
REQUEST FOR LEAVE