Leave of Absence Request

Student Information
I hereby request a Leave of Absence from University of the Southwest beginning the date indicated below. (Leave of Absence forms are effective the date this form is electronic submitted.)
Student ID

Last NameFirst NameMiddle Initial

Mailing Address


Phone NumberPreferred Email Address


Leave Information
I understand that this does not relieve me of any financial obligations to the University. I have read and understand the University's refund policy. I understand if I live on campus I am required to contact the Housing Office at 575-492-2138 to withdraw from housing. I understand a leave could affect my eligibility to receive or maintain financial aid. For more information, contact the Office of Financial Aid at 575-492-2120.
Reason for Leave
Personal Health Financial
Military Other

I am hereby applying for a Leave of Absence beginning on:

I intend to return on:

By selecting typing your full name in the box below and clicking submit, you are agreeing to sign this form electronically and that your typed signature is the legal equivalent of your manual signature.
Full Name