Leave of Absence request form
This form is for matriculated undergraduate students only. Contact Sherill Anderson: email@example.com with any questions. This form notifies the College of your intent to leave. If you are currently enrolled in classes and/or living on campus, submitting this form will withdraw you from classes and notify housing. A Leave of Absence is valid for up to three consecutive semesters.
Graduate students should contact the Graduate School for information about withdrawing from Brockport.
If you are in your FIRST THREE WEEKS of your FIRST SEMESTER at Brockport, you are NOT eligible for a Leave of Absence. You should submit an Early Separation Request Form.