Honors Leave Form

*Last Name

Characters remaining:

*First Name

Characters remaining:

*A#

Characters remaining:

*Permanent Address

Characters remaining:

*City

Characters remaining:

*State

Characters remaining:

*Zip Code

Characters remaining:

*Permanent Phone#

Characters remaining:

*Email

Characters remaining:

*Current Major

Characters remaining:

*Current College

Characters remaining:

Returning

Fall Spring Summer

*Year

Characters remaining:

Reason for Leaving

Attending another college or university Humanitarian Service Religious Mission Study Abroad

Other

Please explain

Characters remaining:

Filled out a Release of Information Form with the Registrar's Office?

No Yes

*Verification : Please answer the question below

How many fingers are there on a human hand?

Honors