Undergraduate Leave of Absence Request Form

Background Information

Enable additional features by logging in.

Reason for Leave(Required):

This field is required.

Learn more

Why are you requesting a Leave of Absence

Date of Request(Required):

This field is required.

Your Information

Your Name

Lehigh ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Current Address

Questions

Please provide the following information:

Semester you are requesting the leave to start:(Required) This field is required.

Semester you plan to return to Lehigh(Required) This field is required.

What is your current class standing?(Required)

Freshman Sophomore Junior Senior

This field is required.

Please provide your cell phone number.(Required) This field is required.

Please provide an ALTERNATE email address (not @lehigh.edu) at which you can be reached.(Required) This field is required.

Please provide detailed information concerning why you are requesting a leave of absence.(Required) This field is required.

Supporting Documentation

Supporting information must include an email or letter from your adviser informing him/her of your leave of absence.

5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Background Information

Your Information

Questions

Supporting Documentation

Submission