Request for Time Away from the PBPM Program

PBPM Request for Time Away from Washington University

From time to time students want to take time away from the Post-Baccalaureate Premedical Program (PBPM) at Washington University.

When you take a Leave of Absence from the University you have the option to return at a later date. Please note that students who do not enroll in any course work in the program for a span of one academic year or more will be required to reapply if they wish to return.

If you do not wish to return to the University as a PBPM student please indicate that below and your time away will be processed as a withdrawal from Washington University.

Personal Information

Student ID # *

First Name *

Last Name *

WashU Email Address *

Non WashU Email Address *

Primary address during absence

If your address will be outside of the United States please select "International" from the state list (the last option) and enter as much address information as possible in the fields below.

Street Address *

City *

State *

Zip *

Primary Phone Number *

Cell Phone Number

Expected Semester to Begin Leave *

Expected Year to Begin Leave *

Have you submitted an Intent to Complete form? *

Yes

Would you like to withdraw your Intent to Complete? *

Yes

Do you plan to take courses at another institution during your absence from the PBPM program? *

Yes

Do you plan to return to the PBPM program in the future? *

Yes

Leave this field blank