BREAK IN ENROLLMENT

BREAK IN ENROLLMENT
USE THIS FORM TO REQUEST A BREAK IN ENROLLMENT

Leave of Absence (LOA): break for LESS THAN two full terms, excluding summer. If in good standing at the time of leave, eligible to return under original catalog if program is still offered.

Withdrawal: Break for two full terms or longer, excluding summer. If granted readmission, return on catalog in effect at time of readmission.

Your break in enrollment is effective the date this form is received by the Registrar's Office OR the last day of the term, if completing term in progress. If you do not return from an approved LOA as scheduled, you will be withdrawn effective the last day of the last term in attendance.
DATE SUBMITTED*

MonthDayYear
Date
NAME*

First NameFamily / Last Name
STUDENT ID*
EMAIL*
example@example.com
CURRENT ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
LEVEL OF STUDY*

UndergraduateGraduateIntensive EnglishNon-Degree
UNDERGRADUATE*

Business AdministrationLiberal ArtsPsychologyUndeclared
GRADUATE*

DBMIN Buddhist MinistryMA Buddhist Spiritual CareMA PsychologyMA Religious StudiesMBA / Professional MBA / Post MBAMDIV Buddhist ChaplaincyPHD Religious Studies
NON-DEGREE*

Undergraduate CertificateGraduate CertificateOpen Enrollment
BA BUSAD CONCENTRATION*

AccountingComputer Information SystemsInternational BusinessMarketingNot Yet Declared
MA PSYCH AREA OF STUDY*

Marriage & Family TherapyMulticultural Counseling (non-licensure)
MBA CONCENTRATION*

NONEComputer Information SystemsData AnalyticsFinanceInternational BusinessNonprofit Organization ManagementDual Concentration
CONCENTRATION 1*
CONCENTRATION 2*
MA RS CONCENTRATION*

NONEBuddhist TextsComparative ReligionHumanistic BuddhismMindfulness, Meditation, & Mind
PhD concentrations applicable only to students who began studies prior to fall 2022.
PHD RS CONCENTRATION*

NONEBuddhist StudiesComparative Religious Studies
INTERNATIONAL STUDENT (F-1)*

NOYES
Federal regulations strictly limit approved time off for non-immigrant students. If you withdraw from all classes, you will be expected to leave the country no later than the deadline set by Immigration & Customs Services. Consult with the International Student Services Advisor before submitting this form to be sure you understand how this change of student status will affect your visa status.
TYPE OF BREAK*

Leave of Absence (out less than two terms)Temporary Withdrawal (out two full terms or more, plan to return)Permanent Withdrawal (do not plan to return)
EFFECTIVE DATE*

IMMEDIATE, submitted during term, dropping all classes in progressEND OF CURRENT TERM, submitted during term, completing classes in progressEND OF LAST TERM COMPLETED, submitted between terms
GRADING: If submitted prior to 5 pm week 10 (fall & spring) or week 6 (summer session 1), W posted in classes in progress; after this date, FW posted.

W does not affect GPA. FW calculates as F.

Both W and FW affect pace of completion. See the catalog for more details.
REASON FOR BREAK *
DO YOU LIVE ON CAMPUS?*

NOYES
Residence halls are open to active students only. Contact the Residential Life Coordinator for your deadline for moving out of the residence.
DO YOU RECEIVE ANY TYPE OF GRANTS, LOANS, OR SCHOLARSHIPS?*

NOYES
Consult with a Financial Aid Officer to determine how withdrawing will affect your aid and any amount due to the university, and whether you will be liable to return any aid already disbursed.
By signing, I verify that I am the student of record. Submission of this form indicates that I authorize the university to update my status. I understand that I am responsible for payment of any tuition and fees due to the university at the time of withdrawal or leave, and that all library materials must be returned. I also understand that if I choose to resume my studies at UWest, reentry or readmission is not guaranteed.
Signature*

Clear
CLEARANCES
ACCOUNTING CLEARANCE

CLEARED BY: DATE:

COMMENTS
ADVISOR/CHAIR CLEARANCE

CLEARED BY: DATE:

COMMENTS
FINANCIAL AID CLEARANCE

CLEARED BY: DATE:

COMMENTS
HOUSING CLEARANCE

CLEARED BY: DATE:

COMMENTS
INTERNATIONAL STUDENT CLEARANCE

CLEARED BY: DATE:

COMMENTS
LIBRARY CLEARANCE

CLEARED BY: DATE:

COMMENTS
REGISTRAR'S OFFICE USE ONLY

Date Processed: Effective Date:

LDA (if needed for FA): SAP Status:

Notes:
Should be Empty: