Return from Leave of Absence, Penn Engineering Graduate Student
This form must be completed by graduate students requesting a RETURN from a Leave of Absence.
Email *
Surname/last/family name:
 *
Given/First Name:
 *
Preferred name (if applicable):
Penn ID (PID) number:
 *
Please list a personal email address (not upenn email) while on leave: *
Telephone number you can be reached: *
Degree Level: *
If you are a PhD student, please list the name of your faculty advisor(s):
Department/Program:
 *
Are you a Dual Degree Student?
*
If a Dual Degree student, please indicate the name of the other school/program:
I am requesting to RETURN from Leave and register for courses for the following semester:  
*
Please indicate the YEAR you will return from leave: *
What type of leave did you take?
*
How many courses do you plan to take in your returning term? 
*
If you have incomplete grade(s) in any of your previous courses, have you finished the work? If not, what are your plans on how you will complete them?
By submitting this form, I confirm that all information is truthful and accurate to the best of my ability and all responses have been completed by myself.  I also give permission for the information submitted to be evaluated and processed by SEAS staff. *
A copy of your responses will be emailed to .
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