CCPS ALOA - SI - Formstack

Request Form for Academic Leave of Absence - CCPS Dean’s Office - Staten Island

Part 1: Student Information

CCPS undergraduate students may apply for a academic leave of absence while enrolled in a degree program at SJU. In order to be eligible for an ALOA students must:

Submit a written request such as the form below to the CCPS Dean’s office
Not be enrolled in any coursework for the semester the leave is requested
Contact financial aid to inform them once the leave is approved
This form can be used to apply for an ALOA for one semester only. If you do not enroll in coursework in the semester immediately following your ALOA, you must readmit before returning to the University.
It may take 3-5 business days for your form to be reviewed.

Student's Name*

First Name

Last Name

X Number*

Requesting Leave of Absence for Which Semester?*

Fall Spring

Requesting Leave of Absence for which year?*

Student Email*

NOTE: FOR A RESPONSE YOU MUST ENTER EITHER YOUR @stjohns.edu OR YOUR @mystjohns.edu EMAIL ADDRESS

Cell Phone Number*

Major*

Track Concentration - Advertising Communication*

Track Concentration - Computer Science*

Track Concentration - Health and Human Services*

Minor (if any) (please list all)

Briefly State The Reason for Requesting an Academic Leave of Absence*

Part 2: Select Your Advising Dean

What is your Advising Dean name? (Please see list below)*

First Name

Last Name

What is your Advising Dean's Email? (Please select one from the list below)*

Advising Deans List

Assisting Students with Last Names Beginning:	Advising Dean Name:	Advising Dean E-mail:
A – Z	Maria Rappa	rappam@stjohns.edu

FOR FALL SEMESTER ALOA

What is your Advising Dean's Email? (Please select one from the list below)*

Registrar Processing of ALOA*

•	Registrar will not process this request until after October 15th.* You may ignore any phone calls/letters about registration and returning your laptop until then.  Should you get any call/letters after October 15th please contact the college office at 718-390-4449

Spring Semester Planning*


•	Spring semester registration begins in October.  Please visit www.stjohns.edu/cpsadvisement after  October 20th to schedule an in person advisement appointment.

Contact Financial Aid*

FOR SPRING SEMESTER ALOA

Registrar Processing of ALOA*

•	Registrar will not process this request until after February 15th.* You may ignore any phone calls/letters about registration and returning your laptop until then.  Should you get any call/letters after February  15th please contact the college office at 718-390-4449

Fall Semester Planning*

•	Next semester’s registration begins in March.  Please visit www.stjohns.edu/cpsadvisement after March 9th  to schedule an in person advisement appointment.

Contact Financial Aid*

Part 3 - Advisors Review/Approval:

This Leave of Absence is: *

Approved is not Approved

Advising Dean Comments ONLY

(Optional) Dean's Signature

Yes No

Use this option if you would like to process this form on behalf of another Dean.

Dean Signature*

First Name

Last Name

Signature

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