Request For Leave of Absence
FGS Graduate Calendar Section 4.06
Student’s Name: Address: City: Province: Graduate Program, Degree: Postal Code: Student Number: E-mail:
Engineering Science - MME
Degree Requirements Outstanding:
Leave requested for the following term(s):
Fall 20 --
Winter 20 --
Summer 20 --
Procedure:
1. Once completed, this form must be accompanied by the following: A separate letter indicating the specific reason for the request for a leave of absence. If the reason is medical, a note from a medical doctor must be provided. Please note that if the request is on compassionate grounds, additional documentation may also be required. A plan indicating timelines for the student’s return to the graduate program, approved by the Graduate Chair and the student’s supervisor. A detailed accounting of all funding the student is currently receiving from the University. 2. The request must be submitted by the appropriate deadline depending on when the student hopes to start the leave of absence: Fall Term: August 1st; Winter Term: December 1st; Summer Term: April 1st. 3. The Faculty of Graduate Studies will notify the student and his/her graduate program in writing of any decision.
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Student Signature Date
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Supervisor Signature Date
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Graduate Chair Signature Date
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Dean of Graduate Studies Date
For FGS office use only: Leave term(s) approved: Fall 20____ Winter 20____ Summer 20____
The personal information on this form is collected under the authority of the University of Western Ontario Act, 1982, as amended. For a complete Collection Notice, visit www.uwo.ca/grad.
Form Revised June 2006