Revised: November 2009
This application is required for those students who will not be returning to SPU. Students planning to return to the
university should complete the “Application for Non-Study Leave of Absence.” If you are in the first two weeks of your 1
quarter at SPU, you will not need to complete this form and should instead contact the Office of Undergraduate
Admissions to cancel your admission status. Please contact them at 206-281-2021 or visit them in Demaray Hall 120.
We understand that at times circumstances or opportunities may arise where you need to stop attending SPU.
Completion of this form will help key offices such as Student Financial Services, Student Life, and Student Academic
Services plan for your departure.
Name: ______________________________________________________SPU ID #: ___________________________________
Mailing Address: _________________________________________________________________________________________
Phone Number: ______________________________________________Email Address: ______________________________
Class Standing: _____________________________________________ Today’s Date:
Quarter You Are Leaving SPU:_______________________________
REASON FOR PLANNED ABSENCE (please circle)
Transferring (please list institution):________________________________
Other (please list): _____________________________________________
COURSES TO WITHDRAW (if applicable)
OR, initial here if you’ve already withdrawn from classes ________________
Please return completed form to Student Academic Services, Demaray Hall 151, Suite 113.
Office Use Only: Entered in Comments Withdrawn from Classes (if app