AUSL Form No.

RO7 - 0718

AUDIO VISUAL
APPLICATION FOR LEAVE OF ABSENCE (LOA) CLEARANCE
Accounting:
Date ____________________
By:

Date:
Atty. Domingo M. Navarro
Remarks:
Dean
I __________________________________________________astudent
of Arellano University School of Law as ________________ (Year Level) with Library:
Student No. _____________________ am applying for a leave of absence for the By:

school year _________________________ for the inclusive semester/s of Date:

____________ and ____________ Remarks:

NOTE:
This application is the clearance issued by the Accounting Office attesting
that I have no outstanding obligation with any department of the school. Office of Student Affairs:
Upon my re-enrollment my General Weighted Average (GWA) will be computed By:

to determine if I am eligible for re-enrollment. Date:

Remarks:
The Dean’s Office has the sole discretion to determine the curriculum to
apply on my re-enrollment

Medical:
REASON/s: ________________________________________________________
By:
__________________________________________________________________
Date:
__________________________________________________________________ Remarks:
__________________________________________________________________

Audio Visual:
By:

Signature over printed name Date:

Remarks:

Attested by:

Guidance:
By:
________________________ __________________________
Registrar’s Office Dean Date:

Date _______________________ Remarks:

REGISTRAR’S COPY