Request For Leave of Absence

After speaking with your Program Advisor, use this form to let the Master's & Certificate Programs office know that you are requesting a Leave of Absence from your program.

1Information > 2Acknowledgement & Signature > 3Review Your Entry
Penn ID
Must be 8 digits. Currently Entered: 0 digits.
Your Penn ID can be found under your picture in Penn InTouch or on your Penn ID card--the 8, bolded numbers.
Confirm Penn ID
Must be 8 digits. Currently Entered: 0 digits.
Name Name First Last
Which program are you currently enrolled in?
Brief explanation of why you are requesting a leave of absence (i.e. personal, work related, military)
Have you spoken to your Program Advisor and received permission to take a leave of absence from your studies?
What date did you first notify your program of your intention to take a leave of absence? What date did you first notify your program of your intention to take a leave of absence? / MM / DD YYYY
Are you finishing the term you are currently enrolled in (completing all coursework, etc.)?

Are you finishing the term you are currently enrolled in (completing all coursework, etc.)? Yes No
Did you or are you dropping/withdrawing from any coursework in the term from which you are taking a leave of absence?

Did you or are you dropping/withdrawing from any coursework in the term from which you are taking a leave of absence? Yes No
Last date of educational activity (i.e. attended class, turned in an assignment, made any course registration changes) Last date of educational activity (i.e. attended class, turned in an assignment, made any course registration changes) / MM / DD YYYY

List the last date of attendance in a class or educational activity that you had.
In what term (i.e. Fall 2025) do you plan to return from leave?
What is your new expected graduation term? (i.e. Spring 2026)
Non-Penn Email (i.e. @gmail.com)

Confirm non-Penn Email Address

Leaves often deactivate your Penn email address or limit your access to it. Please provide a non-Penn email address that you check regularly, in case we need to reach you before you are returned from leave.