Confirmation of Return Form

Name Information

LU ID

First

Middle

Last

Suffix

Phone

Multiple email addresses may be separated by commas. Emails are only sent to cc and bcc addresses if a To email address is provided.

My plans for fall term are as follows:

I plan to return for fall term.

I would like to try to extend my leave.

I do not plan to return to ��ý��Ƶ and would like to withdraw.

I need to have additional information from ��ý��Ƶ before making a decision to return.

I request to extend my leave until:

Please note:

I am withdrawing because:

Please note the following:

I need the following information:

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