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 have read and understand the University's refund policy as stated on the website at www.wcsu.edu/cashiers/refund.asp.

    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.

Please indicate when you plan to return to the University by completing this section.


Students may only request a leave of absence for a maximum of one year.


Leave of Absence forms are effective the date this form is electronic submitted.