Professional Documents
Culture Documents
Leave of Absence
Leave of Absence
Academic Affairs
LEAVE OF ABSENCE FORM
Student Information
STUDENT NAME
STUDENT ID NUMBER
COURSE
YEAR LEVEL
DEPARTMENT
LEAVE INFORMATION
BEGIN LEAVE ABSENCE ON
(MM/DD/YEAR)
ESTIMATED RETURN FROM LEAVE ON
(MM/DD/YEAR)
___Employment
___Health Concern
___Pregnancy
___Travel Abroad
SUPPORTING DOCUMENT(S)
OSA Chairperson
Signature over Printed Name
Date
Dean
Signature over Printed Name
Date
Approved: