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** Note: You must sign this form and acquire the appropriate signatures before submitting it to the Registrar's Office. This form must be submitted at least thirty days before the beginning of the semester you intend to be away from RU. **
Name:
Student ID:
Date:
RU Address:
RU Phone:
Permanent Address:
Permanent Phone:
Alternative Phone:
Major/Option:
Hours Completed:
GPA:
Semester & Year of Academic Leave:
Nature of Academic Leave (attach a copy of the Letter of Acceptance for the program for which academic leave is being requested):
By signing below, I verify that it is my full intention to enroll at Radford University for the semester following my academic leave, and that I understand all of the policies and procedures related to academic leave.
Student Signature Student Name (print)
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Approval Signatures:
Approve
Disapprove
Academic Advisor Date
Approve
Disapprove
Department Chair Date
Approve
Disapprove
Dean Date
The Director for Experiential Learning and Career Development must approve requests for non-credit internships:
Approve
Disapprove
Director of Experiential Learning Date
The Director of International Programs must approve requests for study abroad:
Approve
Disapprove
Director of International Programs Date
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