LOA Update

Please fill in a valid value for all required fields

Please ensure all values are in a proper format.

Are you sure you want to leave this form and resume later?

Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form.

You must upload one of the following file types for the selected field:

There was an error displaying the form. Please copy and paste the embed code again.

There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue.

Request to Update Leave of Absence Duration

Please complete the form below to request a change to your expected date of return for your approved Leave of Absence. Students can revisit the LOA/W Policy for further information.

Who should complete the form:

Students who applied and were approved for a one-semester leave of absence and wish to extend their leave for an additional consecutive semester. If you have been on Leave of Absence for two semesters, you are not eligible to extend your leave.
Students who applied and were approved for a two-semester leave of absence and wish to return to the college earlier.

Students who apply for a LOA extension are highly encouraged to meet with Academic Advising & Student Financial Services located inside the One-Stop to understand any academic/financial implications. Students will receive a notification once a decision is made.

We understand that this is a major decision and we are here to assist you. For any questions or concerns please contact the One Stop at onestop@otis.edu or by calling 310-665-6999

Legal Name*

First Name

Middle Name (optional)

Last Name

X Number*

Phone Number*

Preferred Email*

Major*

Class Level*

Citizenship Status*

US Citizen International F-1 Status Permanent Resident Other Status

Do you have a Minor?*

YES NO

Please Note: International Students on an F-1 Visa are not eligible for a Leave of Absence unless approved by the Primary Designated School Official. Please click here to schedule an appointment with the DSO before submitting this form.

Student Signature

A Leave of Absence is only valid for up to 1 year. If a student does not return within 1 year of the original LOA submission the student will be withdrawn from Otis College. *

I acknowledge that I have read and fully understand the above statement

Changing the duration of a Leave of Absence may further impact a students graduation date and eligibility to participate in the commencement ceremony. Students are highly encouraged to speak with the Academic Advising Office before submitting this form.*

I acknowledge that I have read and fully understand the above statement

Changing the duration of a Leave of Absence may have financial implications. Students are highly encouraged to speak with Student Financial Services before submitting this form.*

I acknowledge that I have read and fully understand the above statement

By signing this box I certify that I am the above-named student and that my electronic signature provided on this form is authentic and has the same validity and legally binding effect as signing this form by my hand in ink.*

I acknowledge that I have read and fully understand the above statement

Signature*

[clear]

Use your mouse or finger to draw your signature above

Academic Advising Verification

Has the student been in contact with you?*

YES NO

Does the anticipated semester of return match with the department sequencing?*

YES NO

Is the students Major currently impacted?*

YES NO

Additional Information regarding sequencing, impacted major, degree status:

Registration Review/Approval

Is the students request for a LOA extension approved?*

YES NO

Why is the request being denied?*

The original Leave of Absence request was processed as a withdrawal. Student must submit a readmission application for their new anticipated semester of return. The original Leave of Absence request has already expired. Student must submit a readmission application at this time. The updated semester of return does not match with the departments course sequence. Student should meet with an Academic Advisor to speak further about the situation. The students Major is currently Impacted. Students should contact an Academic Advisor for further information and to discuss next steps.

Other:

Confirm the semester/year the student has been approved to return to Otis College (Ex: Fall 2020):*

Notes/Comments