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Higher Education Application for Leave of Absence PERSONAL AND PROGRAM DETAILS Family Name Surname

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Higher Education Application for Leave of Absence PERSONAL AND PROGRAM DETAILS Family Name Surname Powered By Docstoc
					                                              Higher Education
                                              Application for Leave of Absence
PERSONAL AND PROGRAM DETAILS
Family Name / Surname                                                                                                    Student Number
Given Names

Date of Birth (dd/mm/yy)

Address

Suburb or Town                                                                                                             State                              Postcode

Telephone Number                                                                               Mobile Phone Number

Program Code                                                                                   Program Title

Campus

INTERNATIONAL STUDENTS
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

CONDITIONS
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
   Invoice).
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
   http://policies.swinburne.edu.au/ppdonline/showdoc.aspx?recnum=POL/2008/312
Privacy Statement: Swinburne University of Technology collects, uses and destroys personal information in accordance with our Privacy Policy which can be viewed at
http://www.swin.edu.au/privacy
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.

Date received
       Approved                    Not Approved                  Due to
Faculty delegate                                                                                                                         Date of Approval
Awarding Faculty

Entered date                                                 Initials
         Fees:            Refund Due                Cheque Req Processed                               Date                                        Initials
                                                                                                                                                                  Last updated: 02/09/2010

				
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posted:8/21/2011
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