graduate leave of absence application by applying for a leave of absence, you may: • retain...

Download Graduate Leave of Absence Application By applying for a leave of absence, you may: • Retain your CU

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  • Graduate Leave of Absence Application

    Office of the Regi strar Regent Adminis trative Center 101 20 UCB Boulder, Colorad o 80309

    t 303 492 69 70 f 303 492 8748 withdraw@colorado.edu

    Revised 3/28/2020

    To qualify for a leave of absence, graduate, law and MBA students must complete the following steps or their application will not be processed.

    1. If not enrolling for a fall or spring semester, students should first submit a withdrawal form. Students are bound by the withdrawal deadlines published in the withdrawal information (in Resources sidebar) for the semester or session.

    2. Department and college approval is required in order to take a leave of absence. This approval is given by including the required signatures on the application. See Required Signatures below.

    Restrictions • No student can be on academic or judicial suspension. • New, readmitted and transfer students who drop all classes by the drop deadline are not eligible. • Graduate and MBA students must have a minimum GPA of 3.0. • Doctoral candidates wh o have passed their comprehensive examinati ons and BAM and concurrent degree s tudents are

    not eligible, with the exception of those taking parental leave. Students with questions or extenuating situations may contact the Graduate School for further guidance (303-492-8220, gradinfo@colorado.edu).

    Student’s Information

    Leave of Absence Information

    First name __________________________________ Last name _________________________________________ MI ________

    Student ID number ____________________________ Phone number ________________________________________________

    Home address _______________________________________________________________________________________________

    State _________________________________ Zip code ______________ City ________________________________________

    College/school/program: ☐ Graduate School ☐ Law School ☐ MBA

    Semester & year leaving

    Semester & year returning

    ☐ Spring ☐ Summer ☐ Fall Year _________

    ☐ Spring ☐ Summer ☐ Fall Year _________

    Reason for applying for a leave of absence _________________________________________________________________________

    Requi red Signatures By signing this form, you agree that the information above is correct.

    Student’s signature ___________________________________________________________________ Date _______________

    MBA Student Services Advisor __________________________________________________________ Date _______________ MBA students must obtain this signature before submitting the application. No dean’s signature is required.

    Graduate, Law or Business Advisor _____________________________________________________ Date _______________ Graduate, law and business students must obtain this signature before requesting their dean’s signature (see below).

    Dean of Business, Education or Music ___________________________________________________ Date _______________ Graduate students in the Leeds School of Business, School of Education or College of Music must obtain this signature after receiving approval from their department.

    Dean of the Graduate or Law School _____________________________________________________ Date _______________ Graduate and law students must obtain this signature after receiving approval from their department.

    International Advisor __________________________________________________________________ Date _______________ International students must obtain this signature from International Student and Scholar Services (Center for Community, S355).

    For Office Use Only Client support staff’s signature ______________________________________________________________ Date ______________ Date entered ___________ Initials _____ Email sent ___________ Initials ______ GPA: _______(GR|MBA) New: Y | N Stops: Y | N

    mailto:withdraw@colorado.edu https://www.colorado.edu/registrar/students/withdraw https://www.colorado.edu/registrar/students/withdraw https://www.colorado.edu/registrar/withdrawal-form mailto:gradinfo@colorado.edu

  • 2

    Benefits While on a Leave of Absence

    Office of the Registrar Regent Administrative Center 101 20 UCB Boulder, Colorado 80309

    t 303 492 6970 f 303 492 8748 withdraw@colorado.edu

    Many of the benefits available during a leave of absence may require additional fees and approval. Please speak to the department that is offering the benefit for more information.

    By applying for a leave of absence, you may:

    • Retain your CU Gold Student Health Insurance Plan (SHIP) for one additional semester. Insurance enrollment deadlines apply regardless of when your leave of absence application is approved. You must contact Patient Services (303-492-5107; patientservices@colorado.edu) to enroll.

    • Secure your financial aid package for the spring semester if you’re going on a leave of absence for fall. Please contact the Office of Financial Aid to see if you qualify (303-492-5091).

    • Purchase a CollegePass through the Buff OneCard Office (303-492-0355).

    • Stay for one additional semester in Family Housing (303-492-6384).

    • Remain employed in a non-work-study position on campus (303-492-7349). o International students may not remain employed.

    • Continue to use pre-purchased athletic tickets for the first semester of inactivity (303-492-8337). o Tickets cannot be purchased unless the student was registered for at least four credit hours.

    • Retain access to: o The Recreation Center for a fee (303-492-6880). o CU Libraries, including book checkout (303-492-8705). o The Center for Inclusion & Social Change (303-492-0272). o Career Services (303-492-6541).

    A leave of absence does not:

    • Defer your loan status. If your loan status changes to repayment, please contact your loan provider to find out more about their policies and withdrawing.

    • Allow students who are withdrawn to continue to use their work-study.

    A copy of the application from the Office of the Registrar may be required as proof to access benefits with certain departments.

    The benefits provided while on a leave of absence are subject to revision without notice. It is your responsibility to contact the department offering the benefit to discuss your individual needs.

    mailto:withdraw@colorado.edu mailto:patientservices@colorado.edu

    Graduate Leave of Absence Application Student’s Information Leave-of-Absence Information Required Signatures For Office Use Only

    Benefits While on a Leave of Absence GraduateLOAForm_second page.pdf Graduate Leave of Absence Application Student’s Information Leave-of-Absence Information Required Signatures For Office Use Only

    Benefits While on a Leave of Absence

    Semester & year leaving: Off Semester & year returning: Off College, school or program: Off Student's first name: Student's last name: Student's middle initial: Student ID number: Student's phone number: Student's home address: City: State: Zip code: Leaving in what year?: Returning in what year?: Clear Form: Print & Sign Form: Reason for applying for leave of absence benefits:

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