Extended Leave Form

NBC extended leave form for current students. Form must be submitted 1 day prior to departure.

See Student Handbook for details about Extended Leave.

NOTE: Please contact staff during business hours of 8am-5pm

Name(Required)

First Last

Email(Required)

Departure Date(Required)

Length of Leave (days)

Please enter a number greater than or equal to 1.

Have you made the Deans aware of your plans?(Required)

Yes

Have you signed out with the Food Services Staff?(Required)

Yes

If needed, have you found a substitute for your Student Work responsibilities?(Required)

Yes

N/A

Who is your Student Work substitute?(Required)

If needed, have you informed your Student Ministry supervisor?(Required)

Yes

N/A

Are you on Academic Probation?(Required)

Yes

Please check with the Academic Dean prior to requesting extended leave.