Petition for Term Break or Leave of Absence (LOA)

Petition for Term Break or Leave of Absence (LOA) Form

  1. Instructions
    To be eligible to take a Term Break or a Leave of Absence (LOA) you must have completed at least one term at PCHS and be in good standing with the college. We recommend meeting with the advising team for guidance, before completing this form.

    An eligible student may stay out of the program on an approved term break for one term without reapplication. Students must attend two consecutive terms before applying for further term breaks. Students in nursing degree programs (Bachelor of Science in Nursing [prelicensure and RN-to-BSN options] and MSN) are not eligible for term breaks. A term break has the same effect as withdrawing from the program regarding financial aid. Students must complete exit loan counseling online at PCHS Financial Aid.

    A leave of absence (LOA) period may be granted to students with extenuating personal circumstances but may not exceed 2 consecutive terms within any 12-month period. A LOA is for an event of unforeseen circumstances, such as medical reasons affecting the student or a member of the student’s immediate family, military service requirements, or jury duty, provided that the combined leaves of absence do not exceed two consecutive terms. A student on an approved leave is reported as attending less than ½ time on NSLDS, effective the date of the commencement of the approved leave.

    If a student does not return following the LOA period, the school will apply its refund policy in accordance with the applicable and published requirements.

    Students requesting a Term Break/LOA are first subject to the college’s withdrawal policy and must make the request prior to the add/drop deadline. Failure to sign the required documentation will result in an unofficial withdrawal.

  2. Student Information

    Please enter your information below.





  3. Required Information

    Please enter the required information below.





    Term Breaks and LOA’s for the current term must be requested before the add/drop period ends. After add/drop, only a petition to withdraw may be submitted until the end of the term. Term Breaks and LOA’s for future terms may be submitted at any time.


    Program (please select all that apply):



    Please select the reason for your term break/LOA request (please select all that apply):









    Please select all that apply:



  4. Acknowledgements
    • Students who do not return the term following a Term Break or Leave of Absence (LOA) will be withdrawn from PCHS.
    • Students who are receiving federal financial assistance are advised to reach out to the Financial Aid office to fully understand the potential impact on their repayment requirements.
    • We recommend that students reach out to student advisors for registration guidance at least 2 months prior to the upcoming term.

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By submitting this form, you attest that the concern or complaint is an honest account of what transpired and agree to allow Pacific College to review and investigate the matter.

The college recognizes that confidentiality is important. The college will make every effort to respect the confidentiality and privacy of all parties involved. When looking into the matter, particularly when a grievance is filed, the school will pay attention to any due process or other rights the accused might have.

The Preferred Name Request form enables students, faculty or staff who wish to identify by a chosen name other than their legal first name the opportunity to request their first name be updated in our systems for the purpose of being seen and referred to by their preferred name. Last names can only be changed by legally changing your name through the court system. Please note that Name Change Request must be approved by the college administration and once approved, may take 7-10 business days to go into effect in our systems. Please refer to the College’s Preferred Name Policy for more information.

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