Scholarship Leave of Absence form

Full Name *

Student ID

Indicate type of Scholarship

Please indicate the semester(s) and year(s) you are requesting the Leave of Absence:

Please indicate the semester and year that you intend to return to the University:

Attach supporting documentation. This must be provided in order to receive full consideration for a Leave of Absence request. Examples of documentation are as follows: doctor's statement, medical bills, and/or documentation regarding the issue that requires you to make this request

One file only.
256 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Attach a typewritten letter that explains the issues or unusual circumstances surrounding your request.

One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

I certify that I have completed all of the necessary steps.

I understand that I must submit the request form, a type written letter, and all supporting documentation.

I understand that this form should only be used for scholarship purposes and that I am responsible for contacting all other university units that need to be made aware of my absence from the University of Louisville.

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