I hereby request a Leave of Absence from Western Connecticut State University beginning the date indicated below.
I understand that this does not relieve me of any financial obligations to the University.
I understand if I live on campus I am required to contact the Housing Office at 203.837.8531 to withdraw from housing.
I understand a leave could affect my eligibility to receive or maintain financial aid. For more information, contact the Student Financial Services Office at 203.837.8580.