Withdrawal / Leave of Absence Form

If you have any questions you may contact the Office of Student Enrollment and Financial Services at 216.397.4248 or enrollment@jcu.edu.

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Student Information

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Student ID

First Name

Middle Initial

Last Name

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Permanent / Home Address

Country

Street

City

Region

Postal Code

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Preferred Email

Cell Phone

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Current Student Type

Undergraduate Student in the College of Arts and Sciences

Undergraduate Student in the Boler College of Business

Graduate Student in the College of Arts and Sciences

Graduate Student in the Boler College of Business

Are you an International student?

Yes

No

Are you a Veteran?

Yes

No

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I am requesting a:

Permanent Withdrawal

Leave of Absence (limited to one year)

Effective:

Immediately

At the end of the semester

Plans to reenroll:

Fall

Spring

Summer

of

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A Leave of Absence can only be initiated if the student does not currently have a balance and has a cumulative GPA of 2.0 or higher.

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Reason(s) for leaving JCU (Please select all that apply):

ACADEMIC

My desired major is not offered

Academic program too demanding

Academic program is not challenging

Other

Which major?

Other, please explain

FINANCIAL

Cost of tuition

Full time work opportunity

Other

Other, please explain

SOCIAL

Living arrangements/roommate

Dissatisfaction with social atmosphere on campus

Sports Participation

Other

Other, please explain

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Future Plans

Include

Transferring schools

Work

No plans at the current time

Transferring to

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My signature below indicates that I fully understand that an initially approved Leave of Absence or Withdrawal is superseded in all cases by the Administrative action of academic dismissal, suspension, or expulsion.

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Student Full Name

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