Return from LOA or Readmission Request

Fields marked with * are required.

This form will generate a readmission enrollment request that must be completed by you, and approved by your Director of Graduate Studies / Program Director, and by Laney Student Affairs. Your program administrator will receive a copy.

More information about this process can be found on our website.

Student Information

Name

EMPLID

Program

Student EMPL ID:

Email:

Date of Birth

Readmission Request

I have contacted my program to discuss my readmission and they are aware that I am submitting this application for readmission.

I was enrolled within the last five years.

Yes

Contact the Laney Graduate School for additional information about how to apply.

What is the most recent semester you were enrolled in the Laney Graduate School?

I am returning from a leave of absence that was officially approved by the LGS and want to re-enroll.

Yes

What Term and Year Do You Want To Return?

Upload an Approved Plan for Return:

Summarize why you unofficially left the program and why are you requesting readmission?

Upload an Approved Plan for Return

You are required to make this decision in consultation with your DGS and the LGS Assistant Dean of Student Affairs. Please confirm you have discussed this decision with them before submitting this form.

I confirm

Contact your Director of Graduate Studies and Program Administrator for assistance.

Confirmation:

I understand that submission of this form will generate a notification to my program DGS and PA.

I understand that I intend to request readmission in the term I noted above.

By typing my name below, I confirm that I understand the information above and that it is accurate.