LEAVE OF ABSENCE APPLICATION
MEDICAL LEAVE OF ABSENCE
Application for Leave Of Absence LOA must be submitted at least 2 weeks before date of commencement.
Application for Medical Leave must be submitted no later than 3 days from certificate date.
Student number (8 digit number)
Family name: ______________________________________
Given name: _______________________________________
Email address (JCU email for all students): __________________________________________________________________
Mobile phone: ______________________________________
Course title: _______________________________
Type of leave:
(Note: For semester leave application, student pass for international student will be cancelled.)
Subject title (for class leave only):_____________________________________________________________________________
Leave of absence period: _____________________________________________________
Study period: _________________
I intend to recommence studies in (for semester leave only): __________________________ Study period: _________________
Reason for request [please tick ONE box]
Others, please specify ___________________________________________________
Please provide further information to support your leave request (please attached documentary proof to support your leave
I declare that the information provided is true and accurate to the best of my knowledge and that I have not willfully suppressed any information. I understand that
information contained in this form is collected for enrolment and administrative purposes, and that some information may be released for administrative purposes.
Personal information will not be passed onto any other external bodies without prior authorization unless a valid legal request has been made.
I understand that, if approved from leave of absence for semester, I will be withdrawn from all subjects for the period of leave granted. I understand that it is my
responsibility to investigate the consequence of this. I understand that I will retain access to my JCU email account during the period of leave and that I must
continue to monitor my JCU emails during this time.
Student Signature: _______________________________________________
Date (dd/mm/yyyy): _____/_____/__________
International students absent from the University for up to 1 trimester will need to re-apply for a
Student’s Pass through Student Services. Students who are absent for more than 1 year will be
treated as new students and will have to complete an application form from the Admissions
department. Students will pay tuition fees based on the prevailing fee structure as at the time the
student signs the new contract. Students will also be subject to any changes in the course curriculum
that may occur. Student Attendance department will advise you if your application is not successful
through your JCU email account.
Leave of Absence Application (Revised March 2015)
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