Notice of Leave of Absence Or Withdrawal from University ____ ______ [PDF]

Notice of Leave of Absence. Or. Withdrawal from University. ____. Last Name. First Name. M.I.. Date. Address. H.F. ID #.

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Idea Transcript


Notice of Leave of Absence Or Withdrawal from University ___________________________

_________________ ____

_________________

Last Name

First Name

Date

M.I.

________________________________________________ _______________________ Address

H.F. ID #

______________________

_______

___________

City

State

Zip Code

_______________________________

_________________________________

Telephone Number

E-Mail Address

Major: ___________________________ Receiving Financial Aid?

Yes

No

Leave of Absence _________________________________

Withdrawal

(Please indicate return semester)

Reasons for the Leave of Absence/Withdrawal (Please check all those which apply)

___ Financial (not Financial Aid)

___ Change of Residence

___ Personal Illness

___ Financial Aid

___ Difficulty with Studies

___ Family Obligations

___ Transferring to another College (please indicate College) __________________________ ___ Other ___________________________________________________________________ Comments: __________________________________________________________________ ____________________________________________________________________________________ _____________________________________________________________________________________ I hearby wish to withdraw from Holy Family University.

Office use Only: PERC ________________________________ Registrar’s Signature

__________________________________

________________

Student Signature

Date

__________________ Date

__________________ Status

Distribution: Business Office, Financial Aid Office, Academic Advising Center, Dean of the School of Study, Director of Residence Life, Public Safety Office, Graduate Office, Athletics

Revised 11/2015

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