Student Affairs - Dean's Office

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

Please make sure to enter your complete WESLEYAN email address as jdoe@wesleyan.edu.

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

YesNo

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.

Please answer the following questions only if you are taking a Leave of Absence. Otherwise, please leave blank.

Please answer the following if you are Withdrawing from Wesleyan. Otherwise, please leave blank.

Reasons for Leaving Wesleyan

Please review each item below and indicate your response of "Yes" or "No" as to whether it applies.

Institutional Fit:

NoYes
NoYes
NoYes
Academic:

NoYes
NoYes
NoYes
NoYes
NoYes
NoYes
NoYes
Personal:

NoYes
NoYes
NoYes
NoYes
NoYes
NoYes
NoYes
YesNo
Campus Life:

NoYes
NoYes
NoYes
NoYes
Financial:

NoYes
NoYes
NoYes
NoYes
NoYes
NoYes

Future Plans

UnsureNoYes