Leave of Absence / Withdrawal Inquiry

We are happy to speak with you about a possible leave of absence or withdrawal. Student situations vary greatly, and we want to provide the best information as it applies to you, so we appreciate you sharing some details with us via the inquiry form below. If you haven’t yet scheduled a phone or Zoom appointment with us to discuss your inquiry, please remember to do so— our online scheduler link is found on the “Submitting an official leave or withdrawal request” page. We look forward to speaking with you soon.

This form should be used by non-MET undergraduate students interested in leaves/withdrawals for Fall / Spring as well as by CGS 1st year students interested in leaves/withdrawals for their required Summer 1 / Summer 2 semester. If you are a graduate student, a non-degree (visiting, guest, non-matriculated) student, or a student enrolled in Metropolitan College (MET), you should discuss your request / arrange your leave/withdrawal through your academic area.

Are you the student?*	I am the studentI am NOT the student
(If you aren’t the student, please enter your information when prompted, then as much information as possible about the student. Thank you.)

Student Information

First Name:*		Last Name:*
Preferred Name (optional):
BUID:		Phone Number:
BU E-mail Address:		Date of Birth:
Undergraduate or Graduate student?:*		Full or Part-Time Student?:*

School / College:

Are you an international student studying in the United States on a student visa?*	YesNo
Do you have on-campus housing?*	YesNo

To provide you the best information on leave/withdrawal implications, please let us know which of the following special programs
(if any) you are enrolled in:*

Please let us know a little more about the timeframe for the inquiry. Are you looking into options well in advance or do you need information due to an emergency? Select the option which best fits your situation. (Note: Deadlines for requesting an LOA/WD are firm. Please click here for dates.)*

What you would like to discuss (select the one that fits best):*

Reason for request:

Was a leave or withdrawal recommended to you?

YesNo

Upon successful submission of this form you will be directed to a confirmation / thank you page. Please be patient as submission can take a few moments.

Your Full Name:		Relation to Student:
Your E-mail Address:		Your Phone Number:

Please let us know who directed you to our office (the USC) to discuss a leave or withdrawal. If multiple answers apply, select the most relevant one.
Academic Dean	Advisor (faculty, professional, other)	Instructor	Other