Leave of Absence Request Form

Purpose:

1. This form is for students (domestic and international) who intend to take a Leave of Absence from their study.
2. International students with a student visa must remain enrolled and attend all classes until a formal response is received
3. Application must be submitted before the last day to withdraw without academic penalty.
4. Financial penalty will apply if application is received after the census date.
5. Student must provide documentary evidence to support a request for leave of absence from studies.
6. Applications based on medical grounds must be submitted with an official certificate/documentation and must include a full impact statement from your Medical Doctor.
7. If you are a government sponsored student or have a sponsorship arrangement, it is your responsibility to ensure that leave of absence is permitted by your sponsor.

Instructions:
1. Please seek advice from Student Advisor before submitting this form.
2. Importantly, complete all required fields in the form. Fields marked with an asterisk (*) are mandatory.
3. Attach all required documents as specified in the form.
4. Label your attachments accordingly (e.g."MedicalCertificate_JohnDoe.pdf").
Student Details
First Name
Last Name
Student ID Number
Student Contact Number
Student Email
Student Type

Student Type Domestic International
2. Course Details
Course Name
Course Code
Campus
3. Leave of Absence details
Start Date Start Date / DD / MM YYYY
End Date End Date / DD / MM YYYY
Session/Intake affected
4. Reason for Leave of Absence
Please tick one box only - Original documentation must be attached to support your reason(s)

Please tick one box only - Original documentation must be attached to support your reason(s) Medical Compassionate/Compelling reasons Other
Please provide a brief statement for your reasons for Leave of Absence
5. Supporting documentation
Please upload your supporting document(s)

Attach Files
6. Student Declaration
I have read and understood the guidelines and advice on this application form. I certify that all information including supporting documentation and proof of identity is correct. I authorise UOW College to contact the professional authority concerned for the purpose of verifying the information provided.

I acknowledge that UOW College, where appropriate, will advise the relevant Commonwealth Government authority of this application. In signing this form I understand that details are protected by the Privacy and Personal Information Protection Act 1998 (NSW).

I have read and understood the guidelines and advice on this application form. I certify that all information including supporting documentation and proof of identity is correct. I authorise UOW College to contact the professional authority concerned for the purpose of verifying the information provided.

I acknowledge that UOW College, where appropriate, will advise the relevant Commonwealth Government authority of this application. In signing this form I understand that details are protected by the Privacy and Personal Information Protection Act 1998 (NSW). I agree and acknowledge
E-Signature
Date Date / DD / MM YYYY
Data Collection Statement

UOW College Australia is committed to protecting your privacy. The information provided in this form will be managed
in accordance with UOW College’s Privacy Policy, available at www.uowcollege.edu.au/support-resources/policies-procedures/.

Leave of Absence Request Form

Leave of Absence Request Form

Purpose:

Student Details

2. Course Details

3. Leave of Absence details

4. Reason for Leave of Absence

5. Supporting documentation

6. Student Declaration

Data Collection Statement