Withdrawal/Leave of Absence Form

Withdrawal/Leave of Absence Form

This form is to be used for the following requests:

• Request A Withdrawal From Relay

• Request A Leave Of Absence From Relay

• Request To Withdraw From Individual Course(s)

• Request A Withdrawal From Certification Support or Extended Enrollment Program

Your request is not finalized until you receive a confirmation email that your request has been processed. It normally takes up to five business days for withdrawals to be processed and up to ten business days for leave of absences to be processed.

If you are exiting, effective at the end of a term, your exit will be processed at the start of the following term in order for your grades to post.

Before submitting this form, it is your responsibility to meet with your advisor, your certification officer (if applicable), and the Office of Student Financial Services to discuss implications. Click here for instructions to contact a Relay staff member.

If you have any questions, please don't hesitate to reach out to us at support@relay.edu.

First Name (or Preferred Name)*

Last Name*

Relay Student Email Address*

Student Number*

Please refer to your digital Student ID card

What is your advisor's name?*

Select

Please select your location.*

Select

What would you like to do?*

Voluntary Withdrawal: Students who determine it is not possible or in their best interest to complete the coursework in which they are currently registered may withdraw to gain perspective on their academic and career priorities

Leave of absence: Students who are actively enrolled (i.e., have started attending classes) may take a temporary leave up to one year (three consecutive terms)

Withdraw from An Individual Course: Students who determine that it is not in their best interest to maintain their current course load, but wish to remain enrolled in some courses may request to withdraw from individual courses after the census date.

Please Note: Withdrawing from individual courses could have financial implications and could result in students being off track to complete their program and/or certification requirements.

Withdraw from Certification Support or Extended Enrollment program: Students who have completed their academic program and no longer need support to pursue certification may withdraw from certification support or extended enrollment prior to the end of the final Spring term.

Submit a voluntary withdrawal

Request a leave of absence

Withdraw From An Individual Course

Withdraw from Certification Support or Extended Enrollment program

Did you discuss this decision with your advisor, Student Financial Services and Certification departments?*

Yes, I discussed the details with my advisor.

Yes, I discussed the details with Student Financial Services Team

Yes, I discussed the details with the Certification Team

No I did not discuss the details with my advisor but did discuss the implications with all relevant Relay teams

No I did not discuss the details with my advisor nor spoke to any Relay teams but fully understand the implications of leaving Relay

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We highly recommend you discuss your decision to withdraw from Relay with your advisor, Student Financial Services and Certification departments to fully understand the academic, certification and financial implications of withdrawing from Relay.

When should we process your request?*

Today's date

At the end of the current term (your exit will be processed at the beginning of the following term in order for your grades from this term to appear on your transcript)

In what term do you plan to return to Relay?

Select

How many courses would you like to withdraw from?

Select

Individual Course Withdrawal Entry

Please select the name of the course(s) you would like to withdraw from as the course appears in My Relay Portal.

Select

Select the MAIN Reason for your request.*

Select

Please explain OTHER reasons not listed above*

What if any factors, if changed for the better, would have facilitated you to stay at Relay?*

Your input is highly appreciated and valuable to us. A member of the Student Affairs and Student Services team will get in touch with you within the next 48 business hours. In the meantime, please proceed to answer the questions below to finalize your withdrawal form submission.

File Upload*

Students who wish to request a compelling personal circumstances leave of absence must submit official documentation with their leave of absence request to demonstrate that temporary leaves or accommodations are necessary (e.g., doctor’s note, copy of death certificate, documentation of damage from natural disaster).

Drag and drop files here or

Are you part of the Residency program?*

Select

Please take a moment to read through the Relay AmeriCorps Information*

Any student participating in Relay’s AmeriCorps program who decides to take a leave of absence or withdraw from Relay, must notify Relay AmeriCorps of their intent to exit (officially end) or suspend (temporarily put on hold) their AmeriCorps term of service. Students should email Relay AmeriCorps at support@relay.edu once their Relay exit has been fully processed and confirmation email is received.
Students who do not plan to return to Relay before the end of your service term must complete all AmeriCorps early exit paperwork.
There are two (2) different types of AmeriCorps early exits. Click here to understand impact on Education Award and potential Relay tuition implications.
For further information, please reach out to Relay's AmeriCorps Residency directly at support@relay.edu.

I acknowledge that I have read, understand, and agree to

the AmeriCorps policies

AmeriCorps Consent*

If you were enrolled in the Relay AmeriCorps program, you may be eligible to earn a partial Segal AmeriCorps Education Award for the hours you served. Please select 'I Consent' if you grant permission to the Registrar's Office to share your supporting documents with Relay AmeriCorps. If applicable, Relay AmeriCorps may reach out to you with more information.

Select

Policy Acknowledgement

Please take a moment to read through the withdrawal acknowledgement below.*

Academic Information

You are responsible for submitting all coursework and meeting all submission deadlines or arranging alternative accommodations with your professors until your leave has been officially processed.
Once this application has been processed by Relay, you can no longer submit assignments for your courses.
Any incomplete(s) granted from a prior term will be changed to the standing grade in that course once the withdrawal is processed

Census Date Information

Withdrawing after the Census Date

You are responsible for paying any out of pocket tuition balances
The courses in which you are enrolled will appear on you transcript with a W (Withdrawal) and you will not receive partial credit for any coursework.

Withdrawing before the Census Date

The courses in which you were enrolled and respective coursework completed will not appear on your transcript and you will not receive partial credit for any coursework.

Withdrawing between Terms

Grades will be posted on your transcript for the term that ended. Your exit will be processed after the start of the following term.

Certification Information

If you are on a certification seeking track, once your withdrawal has been processed, your teaching certificate may be expired.

Financial Information

You will no longer be eligible for federal financial aid.

I acknowledge that I have read, understand, and agree to Relay's withdrawal policies

Please take a moment to read through the leave of absence acknowledgement below.*

Students must have started coursework (and participated in classes) in order to take a leave of absence. Students who have not attended class are not eligible to take a Leave of Absence.

Academic Information

•You are responsible for submitting all coursework and meeting all submission deadlines or arranging alternative accommodations with your professors until your leave has been officially processed.

•The Office of the Provost will review your leave of absence request.

•Once this application has been processed by Relay, you can no longer submit assignments for your courses.

•A leave of absence is valid for up to three consecutive terms. If you are unable to return after three terms, Relay will withdraw you from the program.

Census Date Information

Taking a leave after the Census Date

You are responsible for paying any out of pocket tuition balances

• The courses in which you are enrolled will appear on you transcript with a W (Withdrawal) and you will not receive partial credit for any coursework. After one year, if you do not return to Relay, your leave of absence on record will be changed to a Withdrawal.

Taking a leave before the Census Date

• The courses in which you were enrolled and respective coursework completed will not appear on your transcript and you will not receive partial credit for any coursework.

Withdrawing between Terms

• Grades will be posted on your transcript for the term that ended. Your exit will be processed after the start of the following term.

Certification Information

•If you are on a certification seeking track, once your leave of absence has been processed, your teaching certificate may be expired.

•Once your leave is processed, you are highly recommended to complete any outstanding certification requirements (e.g., Praxis exams, CST exams, workshops, etc.) prior to your return.

Financial Information

•You will no longer be eligible for federal financial aid.

Returning from a Leave of Absence

•In most cases, you should return at the beginning of the term which you left (i.e., in one year). Click here to view Relay's term dates.

•To return, you will be required to submit a reenroller/transfer application at least two months prior to the start of the requested term or reenrollment.

• You must already have a teaching or leading position to be considered for reenrollment.

• You must resolve your past due balance to be approved by Student Financial Services

• If you return to a different program, major, and/or area of study, there may be additional coursework requirements to complete your program

I acknowledge that I have read, understand, and agree to Relay's leave of absence policies

Please take a moment to read through the withdrawal from extended enrollment acknowledgement below.*

Please review full information on the Extended Enrollment policy here.

Census Date Information

Withdrawing after the Census Date

You are responsible for paying any out of pocket tuition balances
You will be graduated as of the end of the term and recommended to the state for your initial certificate (where applicable)

Withdrawing before the Census Date

You will be graduated as of the end of term and recommended to the state for your initial certificate (where applicable)

Withdrawing between terms

You will be graduated as of the end of the previous term and recommended to the state for your initial certificate (where applicable)

Certification Information

If you are on a certification-seeking track, once your withdrawal has been processed, your teaching certificate may be expired.

Financial Information

You will no longer be eligible for federal financial aid.

I acknowledge that I have read, understand, and agree to the policies

Please take a moment to read through the withdrawing from an individual course acknowledgement below.**

Please review full information on the Withdrawing from an Individual Course policy here. *

By selecting to withdraw from a course, I understand that there may be financial implications. I also understand that withdrawing from a course could potentially delay my program completion date and certification.

Census Date Information

Withdrawing after the Census Date

You are responsible for paying any out-of-pocket tuition balances
The courses in which you are enrolled will appear on your transcript with a W (Withdrawal) and you will not receive partial credit for any coursework.

I acknowledge that I have read, understand, and agree to Relay’s individual course withdrawal policy.

I understand that I am exiting Relay for the effective term:*

Select

Submission Review & Consent*

By signing my name below, I understand the terms of my withdrawal or leave of absence. *

Send me a copy of my responses

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