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LEAVE OF ABSENCE OR UNIVERSITY WITHDRAWAL FORM

Leave of Absence forms are due by APRIL 1 for the Fall semester and DECEMBER 1 for the Spring semester.

Withdrawal from the University forms are due by the last day to withdraw from full-semester courses.
Check the academic calendar for exact dates.

This form must be completed before your Leave of Absence or Withdrawal
from Wesleyan will be processed.

You also must consult with your faculty advisor about your plans.

International Students

For SEVIS purposes, please see the Coordinator for International Student Services prior to submission of this form.

Personal Information
First Name:
Last Name:
WesID:
Class:
Please make sure to enter your complete WESLEYAN email address as jdoe@wesleyan.edu.
Wesleyan Email Address :
Phone:
It is important that you contact your faculty advisor(s) to discuss your plans.
Have you consulted with your faculty advisor about your plans?:	YesNo
List the names of your faculty advisor(s):
Future Enrollment Status
Please select the appropriate enrollment status (Non-academic Leave, Academic Leave, Withdrawal from Wesleyan) from the list below. If you are planning on taking classes while on leave, make sure to submit pre-approved Permission to Transfer Credit forms to the appropriate departments PRIOR to making arrangements to take the class. If you have questions, please see your class dean.
Type of Leave:
Please answer the following questions only if you are taking a Leave of Absence. Otherwise, please leave blank.
If this is a leave, semester for leave to start (Fall, Spring):
If this is a leave, year for leave to start (e.g., 2012):
If this is a leave, Intended Completion Term (Fall, Spring):
Intended Completion Year (e.g., 2013):
If taking an Academic Leave, what institution will you be attending?:
Please answer the following if you are Withdrawing from Wesleyan. Otherwise, please leave blank.
Requested Withdrawal Date (mm/dd/yyyy):
Reasons for Leaving Wesleyan
Please review each item below and indicate your response of "Yes" or "No" as to whether it applies.
Institutional Fit:
Size (Wesleyan is too big or too small):	NoYes
Setting (Want to be in a city or more rural setting):	NoYes
Housing (Limited off-campus housing options):	NoYes
Academic:
Could not get classes wanted/course access:	NoYes
Major not offered/want more professionally-oriented program:	NoYes
Did not connect with faculty:	NoYes
Insufficient academic support services/resources:	NoYes
Lack of motivation:	NoYes
Not doing well or performing to ability:	NoYes
Not enough research opportunities:	NoYes
Personal:
Physical health:	NoYes
Mental/emotional health:	NoYes
Not ready for college/should have taken gap year:	NoYes
Tired of being in college:	NoYes
Work/internship/volunteer opportunity/experience:	NoYes
Travel/Discover myself/Follow my dream:	NoYes
Family: Want/need to be closer to home/spend more time with family:	NoYes
Campus Life:
Did not find my group of friends:	NoYes
Did not enjoy social life:	NoYes
Student body too homogeneous/Not enough diversity:	NoYes
Student groups/clubs did not reflect my interests:	NoYes
Dissatisfied with athletic experience (not enough playing time/not Division I):	NoYes
Financial:
Did you receive financial aid from Wesleyan?:	NoYes
Cost: Not awarded financial aid/insufficient financial aid awarded:	NoYes
Recent changes in family's financial circumstances:	NoYes
Need to work in job outside of school:	NoYes
Less expensive study abroad option:	NoYes
Future Plans
Do you plan to return to Wesleyan?:	UnsureNoYes
Please use this space to provide additional comments:

LEAVE OF ABSENCE OR UNIVERSITY WITHDRAWAL FORM

International Students

Personal Information

It is important that you contact your faculty advisor(s) to discuss your plans.

Future Enrollment Status

Reasons for Leaving Wesleyan

Future Plans