Withdrawal & Leave of Absence

Students should meet with their academic advisor and Specialty or Program Director to discuss their leave of absence or withdrawal request prior to completing this form.  This form must be completed by all students who wish to go on leave of absence or terminate their study in good standing. A student who fails to submit this form to the School of Nursing, properly completed with the Specialty Director’s and Associate Dean’s signatures will not be granted withdrawal in good standing and will be liable for any tuition, continuous registration fee, or Yale hospitalization insurance charges for the remainder of the academic year in which the withdrawal or leave of absence occurs.

Withdrawal & Leave of Absence
Please indicate the year from which you wish to withdraw.
Please list all courses (course name/number) that you finished and expect to receive a grade in. Remaining courses will be listed on your final transcript with "W" to indicate withdrawal.
Decision and Reason
Forwarding Information
Approved E-mail Addresses
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