Home | Sitemap | Search
Leave of Absence Form


First Name: 
Last Name: 
Student ID: 
Email: 
Address Line 1: 
Address Line 2: 
Address Line 3: 
City: 
U.S. State:  (Only required for US)
State/Province: 
Postal Code:  (Only required for US)
Country: 
Phone:    Ext:  
My last day of class will be: 
Display Calendar (mm/dd/yyyy)
I plan to return: 
Display Calendar (mm/dd/yyyy)
 
A Leave of Absence can be taken for up to one year. Note that some programs can only be started in the Fall semester. For further information, please consult with your Program Director or Advisor. Students may take only one Leave of Absence (see the Student Handbook for additional details). It is your responsibility to contact the Registrar’s Office in writing and to enroll in the term that you have been approved to return. Failure to contact the Registrar’s Office to enroll in your approved return term during the priority registration period may result in withdrawing you from Phillips. You would then need to re-apply to the program and be subject to all admission requirements in effect at the time of your application.
Reason for requesting leave: 

Explanation:
I am receiving Financial Aid: 
My Current Program is: 








My Major is: 
 
I understand the Phillips Graduate Institute policies on Leave of Absence as published in the current edition of the Student Handbook and I will abide by these policies. I understand that it is my responsibility to notify the Registrar's Office in writing of my intent to register: by June 1st if returning in the Fall term, by October 1st if returning in the Spring term.


Enter the last four numbers of your Social Security number
or your birthdate (MMDDYYYY) for identification
NEWS & EVENTS
Sundays at CalFam (details)

Sundays at CalFam (details)

Admissions Information Session (details)



CONT. EDUCATION
PSY 650AX Postmodern Therapy Approaches I (45hrs) (details)

Working with Children- Social Skills and Violence Prevention (31hrs) (details)

PSY 602X Addiction Recovery Case Management: From Assessment to Paperwork (details)

Copyright Phillips Graduate Institute, All Rights Reserved Website Development by Regency Web Services, Inc.
Web Site v1.1 (Build 3.3) (10/18/2007 06:56 AM) / Ready-Flex-Go v1.5 (Build 0.80)