REQUEST FOR A LEAVE OF ABSENCE (LOA)
The LOA is not approved until the Dean of Students signs and dates this form and you receive an e-mail of confirmation to your SGU e-mail account
Be aware that scheduling changes may cause difficulty upon re-entering the academic program after an LOA
Be aware of the timeline restrictions for completing your degree as described in the Student Manual. Time on LOA counts as time toward your degree.
Prior to submitting this form you must discuss the impact of an LOA on your tuition and on your finances with Student Finances AND with a
Financial Aid Counselor if you receive financial aid AND with your sponsors if you are a scholarship recipient
You must discuss this decision with your Faculty Advisor if you are currently in the Caribbean.
By the ending date of this LOA, if you do not register, or request and receive an extension for a 2nd LOA, you will be dismissed for failure to register.
A&S (UG) A&S (Grad) MPH MSc MD (Pre-Med) DVM (Pre-Vet) MD (Basic Sciences)
MD Dual Degree DVM (Basic Sciences) DVM Dual Degree
Student Name: __________________________________Banner ID#:___________________ Matric Date________
Current Term__________________________________ Email Address (SGU ONLY) _________________________
Current Contact Phone #_______________________________ Contact number while on LOA _________________________
Have you taken a LOA before? Y N (If yes) Which Term(s) _______________________
Have you entered the IAP before? Y N (If yes) Which Term(s) _____________________ (MD & DVM only)
I am applying for a Leave of Absence beginning on (date) ___________________ and ending on (date)__________________
for the following reasons (check all that apply—this will not be recorded on your transcript):
Academic Financial Personal Health (letter from physician required) Other (describe below)
Please provide an adequate description of your reason(s) to allow the Dean of Students to make a decision
(Use additional paper if needed)
Comments by Faculty Advisor (Please indicate the impact of this LOA on the student’s academic program—your comments will contribute to
the decision that is made)
Print Name Sign Date:
Please list the courses you are currently enrolled in and indicate if, at the time of this LOA request, you are receiving a passing or a failing grade. If there
have been no assessments yet, write NA. Medical and Veterinary students, you must print out your current grades from ANGEL and attach them to this
application. (Note, this information is not recorded on the transcript).
Course Name (Passing/ Course Name (Passing/
1. I have spoken to student finances and I understand the effect of taking an LOA on my tuition.
2. I receive loans processed by the Financial Aid Office and I have contacted a Financial Aid Officer to discuss the impact of
taking an LOA on my loans
I do not receive loans processed by the Financial Aid Office
3. I receive a scholarship and I have contacted my sponsor to discuss the consequences of taking an LOA on my funding
I do not receive a scholarship
4. I understand that I must resume attendance or apply and be granted an extension of my LOA by the end of my LOA or I will
be dismissed from SGU
5. I understand that, until I receive an e-mail from DOS indicating that my LOA application has been processed and approved,
I am still enrolled in my courses. If I do not participate in required academic activities and my application is not approved, this
is likely to negatively impact upon my grades.
6. I understand that I must check my snail mail and e-mail while on LOA as I am responsible for the information sent to me by
SGU while on LOA; I must ensure that the contact information that SGU has for me is current.
Student’s Signature Date
DOS Approval and comments
IME needed Yes No
Grades recorded W I
Office of Enrolment Planning
Received by: Date: