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LEAVE OF ABSENCE FORM20104176244
Return completed form to: Level 1, 171 Elizabeth Street Brisbane QLD 4000 Email: email@example.com Tel: 07 3210 2200 Fax: 07 3210 2247 CRICOS 02563D Building better futures since 1975 LEAVE OF ABSENCE FORM Student Number: Telephone Number: Family Name: First Name: Course Enrolled: LEAVE OF ABSENCE I wish to take Leave of Absence at Kelly Colleges from: (dd/mm/yyyy) I intend to return to study on: (dd/mm/yyyy) Total duration of leave of absence: (days) Reason of leave of absence application: IMPORTANT INFORMATION • 12 weeks minimum enrolment required to apply for leave of absence • Leave of Absence will not be granted if - there is insufficient time in which to complete your award program; or - fees and charges are outstanding. • Leave of Absence does not avoid exclusion under academic progress requirements. • Approval is under the discretion of Kelly Colleges and may be granted under the following circumstances: Evidence Required Serious illness ---- Medical certificate Psychiatric illness ---- Psychiatric assessment Death of immediate family member ---- Death certificate Visit of immediate family member ---- Copy of flight tickets under family name. Signature Date Office Use Only Document Received by: Date Recei Date Processed: Leave of Absence: Approved Rejected Signature: Leave of Absence Request Form -v3 110809
"LEAVE OF ABSENCE FORM20104176244"