Oregon College of Art and Craft LEAVE OF ABSENCE REQUEST Students may take up to two consecutive semesters for a Leave of Absence. If the student returns to the college within one year, the student is eligible to re-enroll. For financial aid, a student may be on a leave for a maximum of 180 days in one 12month period. If the student does not return, the student is considered withdrawn as of the last date of attendance. Name: Last Date of Attendance: Leave is to Begin: Expected Return to OCAC:

Fall Fall

Spring Spring

Contact While on Leave: Street City

State

Phone:

Zip /

home

cell

Email: Reason(s) for requesting a leave (Check all that apply): Family concerns

Health

Change in educational goals

Financial

Curriculum Attending another institution: Other--Please be specific: I hereby request a leave of absence and will notify the Registrar’s Office of changes (e.g., address, early return from leave, extension of leave, not returning from leave). If I do not return to the College by the Expected Return semester indicated above, I will be withdrawn from OCAC as of the last date of attendance. I am responsible for all matters such as academic or financial pertaining to my enrollment at the College while on Leave. Recorded by Department / Staff: 

Student

Date

(Initials / Date) 

Registrar

Dept. Chair

St. Services (Initials / Date)

Date 

Bursar (Initials / Date)

Financial Aid

Date



Library (Initials / Date)

Student withdrawn and officially on Leave as of: __________