Vice Provost and Dean of Students Office

Leave of Absence/Withdrawal Form

PLEASE NOTE: Students wishing to take any type of voluntary leave from the University must follow established policies and protocols. Completion of the Leave of Absence/Withdrawal Form does not replace these processes.

In addition to the completing the Leave of Absence/Withdrawal form, students MUST contact the Student Services team within their College Dean's Office in order to request a formal leave and to complete additional required paperwork (i.e. a Change of Student Status form).

This form is for undergraduate students only - to request a leave of absence through the Graduate College, please visit https://www.uvm.edu/graduate/resources.

Today's Date *

Year

Month

Day

Person Completing Form (if not student)

Student Information

Last Name *

First Name *

Middle Initial

UVM NetID *

UVM College/School *

College of Agriculture and Life Sciences

College of Arts and Sciences

College of Education and Social Services

College of Engineering and Mathematical Sciences

College of Nursing and Health Sciences

Grossman School of Business

Rubenstein School of Environment and Natural Resources

Note: if you are a Graduate student seeking a leave of absence, please visit uvm.edu/graduate/resources.

Class Year at Time of Departure Other...

Did you transfer to UVM from another undergraduate institution? *

Yes

Which school/college did you attend prior to enrolling at UVM?

Email Address

Personal *

Please note N/A if you do not have a personal email address.

University *

Semester of Leave/Withdrawal

I wish to leave UVM in... (select semester) *

Summer

Fall

Spring

Year of leave (e.g., 2020) *

I am leaving UVM for the following reasons: (Check all that apply.) *

I am leaving UVM for the following reasons: (Check all that apply.) Other...

Duplicate

Personal (individual circumstance)

Campus Climate/Environment (individual response to place)

Academics

Financial

Medical: Mental Health

Medical: Other

Other: Please explain below.

Please tell us more about your decision to leave. If there are other reasons for your departure, please list them here: *

Plans for Re-entry

I plan to leave UVM temporarily and will hope to return at a later date. *

Yes

Unsure

I plan to return to UVM in:

Spring

Summer

Fall

Planned year of return:

Plans to Transfer

I am planning to transfer out of the University of Vermont:

Yes

Unsure

Upon transferring, I plan to attend the following institution:

My new institution is within my home state:

Yes

Please note that it is the student's responsibility to contact the applicable departments listed below at the time of departure from the University. Failure to contact the appropriate offices may result in additional fees and/or loss of eligibility for future services. Note: This information will be sent to each student via email upon receipt of completed form.

Student Financial Services, (802) 656-5700, sfs@uvm.edu
Residential Life, (802) 656-3434, reslife@uvm.edu
Dining Services, (802) 656-4664
Student Accessibility Services (SAS), (802) 656-7753, access@uvm.edu
Honors College, (802) 656-9100
Office of International Education, (802) 656-4296
Student Veteran Services, (802) 656-0581

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Office of the Vice Provost and Dean of Students

Vice Provost and Dean of Students Office

Leave of Absence/Withdrawal Form