BA Academic Leave Request Form

If you are considering taking an academic leave, you are strongly advised to meet with your Academic Advisor or First Year Seminar instructor/Student Success Center Coordinator for advice and guidance before making a final decision.

Personal information
Name Name First Last
LCC student email
Personal email
Contact details
Home address Home address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone
Where are/were you living while at the university?

Where are/were you living while at the university? At home In university-run accomodation In other private accommodation
Have you already discussed academic leave with anyone at the university? (Check all that apply)

Have you already discussed academic leave with anyone at the university? (Check all that apply) Academic Advisor An Instructor FYS Instructor Student Success Center Career Development Center Other (please specify) Other (please specify)
Before deciding to take an academic leave have you contacted any student support services while at University? (Check all that apply)

Before deciding to take an academic leave have you contacted any student support services while at University? (Check all that apply) Student Success Center LCC Counselor LCC Chaplain SFS Office Academic Advisor Residential Staff Library Staff Career Development Center Other (please specify) Other (please specify)
Academic leave effective date

Academic leave effective date Immediately End of the current Fall or Spring semester
Academic leave period

Academic leave period 1 Semester 2 Semesters

You are only allowed to take academic leave for a maximum of 2 semesters in a row.
Would you consider coming back to LCC?

Would you consider coming back to LCC? Yes No

Students who plan to return to LCC will receive an informational email about readmission procedure from the Registrar’s office 2 months prior to the upcoming semester to the personal email indicated above.
If yes, when?
Reasons for taking an academic leave

(select all that apply)
Personal reasons

Personal reasons Unsure of career goals Medical or mental health difficulties Family member with medical or mental health difficulties Personal difficulties Academic difficulties Did not enjoy commuting Homesick Other, please specify Other, please specify
Academic reasons

Academic reasons Major not offered at LCC Difficulty balancing/managing university workload Experienced difficulty academically Experienced difficulty with academic advising Lack of communication with faculty Lack of class choices Did not receive math and/or writing tutoring Attendance requirements Lack of latest trend courses Too many required non-major courses Other, please specify Other, please specify
Financial reasons

Financial reasons Encountered unexpected change in finances Did not receive financial aid Did not apply for financial aid Did not receive loan or other funds Found financial obligation to be too hard on self/family Entering work-force full-time Other, please specify Other, please specify
Social reasons

Social reasons Not connecting with other students Lack of social activities that interest me Difficulties living on-campus Difficulties living off-campus LCC’s Christian worldview does not match my personal values Other, please specify Other, please specify
Institutional reasons

Institutional reasons Cultural atmosphere does not meet my expectations LCC is too small LCC is too close to my home LCC is too far from my home Other, please specify Other, please specify
What are you planning to do next?

What are you planning to do next? Take up employment Look for employment Transfer to another university/college
Please tell us the name of the university
Please tell us why you selected the new university/college
Additional Comments (optional)
IMPORTANT: TRP or Visa will be canceled for international students immediately after academic leave is processed.

IMPORTANT: TRP or Visa will be canceled for international students immediately after academic leave is processed. By checking this box and typing my name below I indicate my understanding and agreement with the academic leave, cancelation, financial aid and refund policies
Name (acts as your digital signature) Name (acts as your digital signature) First Last
Date Date / DD / MM YYYY

BA Academic Leave Request Form

BA Academic Leave Request Form

Personal information

Contact details

Reasons for taking an academic leave