WITHDRAWAL/LEAVE OF ABSENCE FORM

MASTER'S & PHD CENTER Withdrawal/Leave of Absence Form

Name(Required)

First Last

BU ID(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

BU Email(Required)

This form will not be accepted without an official BU email address.

Academic Advisor(Required)

Program of Study(Required)

Type of Leave(Required)

Withdrawal

Leave of Absence

Effective Semester(Required)

Number of Semesters for Leave of Absence

Please note summer terms do not count toward number of semesters of leave.

Reason for Leaving(Required)

Are you an international student in F-1 or J-1 immigration status?(Required)

Yes

If yes, you must consult with your ISSO advisor prior to taking a leave of absence or withdrawing.

Name of ISSO Advisor(Required)

Date of Meeting(Required)

Please carefully read the following statements. By checking each box, you are certifying your understanding of each below.(Required)

REFUNDS: Recipients of Financial Assistance must request a refund in writing through the Office of Financial Assistance. All other students must request a refund in writing from Student Accounting Services, 881 Commonwealth Avenue, Basement Floor. Please refer to the Registrar's Office website, bu.edu/reg for the current semester's Refund Schedule.

STUDENT HOUSING: Please note if your Withdrawal/Leave of Absence will be effective for the current semester, you are required to vacate University Housing within 48 hours of submitting the Withdrawal/Absence form.

DECLARATION OF INTENTION: By checking this box I declare my intention of Withdrawal/Leave of Absence.

ELECTRONIC SIGNATURE: By checking this box I certify that the information provided on this application is accurate.

Boston University Questrom School of Business

Rafik B. Hariri Building
595 Commonwealth Avenue
Boston, MA 02215

MBA CENTER

CONTACT
mbacenter@bu.edu
617.353.7800

OFFICE HOURS
Fall & Spring
Appts: M-Th 9am – 6:30pm, F 9am – 5pm

Summer
M-T 9am – 5pm, W-Th 9am – 6:30pm, F 9am – 1pm

HAR 416

FOLLOW US
@questrom_MBA

SPECIALTY MS & PhD CENTER

CONTACT
qstmsphd@bu.edu
617.353.2673

OFFICE HOURS
Fall & Spring
M-F 9am – 5pm
HAR 402

FOLLOW US
@questromgrad

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