Application for Leave of Absence
PERSONAL AND PROGRAM DETAILS
Family Name / Surname Student Number
Date of Birth (dd/mm/yy)
Suburb or Town State Postcode
Telephone Number Mobile Phone Number
Program Code Program Title
Are you an international student holding a student or AusAID visa? Yes No
Do you hold a scholarship from a government or organisation (other than Swinburne)? Yes No
If yes, you must have approval for leave from your sponsor and the Sponsored Students Unit. You must attach written approval from the Sponsored Students Unit.
International students holding a student or AusAID visa are only permitted to take a leave of absence in compassionate or compelling circumstances and the
Department of Immigration and Citizenship (DIAC) will be advised of any approved leave. Taking leave may affect a student’s visa. Students are responsible for
ensuring that they have a valid visa.
Refunds to on-campus international students are governed by the International Student Enrolment and Tuition Fee Policy: http://www.international.swinburne.edu.au/
feepolicy. Refunds must be applied for at Swinburne International and will not be processed until the leave of absence is approved.
APPLICATION FOR LEAVE OF ABSENCE FROM PROGRAM
LEAVE OF ABSENCE PERIOD Reasons for applying for leave of absence (International students on student or AusAID visas must have compassionate
or compelling reasons supported by documentary evidence eg. counsellor's letter or statutory declaration).
Teaching Period Year
Date of class last attended
1. For domestic students the last date to lodge an application for leave of absence without a Financial Penalty is by close of business on the Unit of Study Census Date
OR prior to commencement of classes for unit of study undertaken in block mode. (For Unit of Study Census Date refer to your Confirmation of Enrolment/Tax
2. Refunds are subject to the return of your University ID card, fee receipt, and any other University property or materials you may have in your possession.
3. No refund of fees will be made after close of business of the Unit of Study Census Date.
4. Before applying for leave of absence students are advised to read the Higher Education 'Deferral and Leave of Absence' policy and procedure
SIGNATURE OF STUDENT DATE
OFFICE USE ONLY
In the case of international students on student or AUSAID visa LOA can only be approved if the student has compassionate or compelling reasons. In the case of
sponsored international students, LOAs cannot be processed without written approval from the Sponsored Students Unit.
Approved Not Approved Due to
Faculty delegate Date of Approval
Entered date Initials
Fees: Refund Due Cheque Req Processed Date Initials
Last updated: 02/09/2010