Leave of Absence Request This field is hidden when viewing the formSteps RequestA leave of absence from the university must be initiated by the student. The LOA process begins by completing this form, after which you will be contacted by the PhD Office to finalize your LOA.Student Name*Student ID Number*Student Email* Duration of absence*One sessionOne semesterOne academic yearPermanentlyIntended Date of Return*Please review the , and indicate your intended session and date of return.Reason for absence*AcademicFinancialMedicalPersonalMilitaryLast Date of Class Attendance*Please help us assess the quality of your experience here. If you would take a few moments to respond to the following, the information you provide may help us improve the Indiana Tech experience for future students. Is there anything else about your experience at Indiana Tech (positive or negative) that you think we should know about, which might improve the experience of future students?Please use this space to make any comments regarding this LOA request.Effective date of absence/exit date MM slash DD slash YYYY By checking this box I am acknowledging that I will be financially responsible for the implications of this absense based on the Ph.D. program's Leave of Absence Policy. I understand I can contact the Student Financial Services office with specific questions regarding the financial implications of my absence.* I understand. Signature*By entering your first and last name, you confirm that the information you have entered is accurate.Date* MM slash DD slash YYYY ResponseYour name*How would you like to respond? Confirm Decline More information needed **If you select “More information requested”, note that you will need to eventually click the “Respond to this Request” link in the original request again in order to re-gain access to this form and provide your eventual response of Confirm or Decline.CommentsComments will be received by both department staff AND the requesting student.Provide More InformationCommentsFollow-up ResponseYour name*How would you like to respond?* Confirm Decline Comments
