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Application for Leave of Absence Form
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Application for Leave of Absence Form
Application for Leave of Absence Form
Personal Detail
First Name
(Required)
First
Surname
(Required)
Student No
(Required)
Course Code
(Required)
No and street (or PO Box no):
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Telephone
(Required)
Email Address
(Required)
International Student
Yes
No
The first study day LEAVE i to take effect from:
(Required)
DD slash MM slash YYYY
The first study day of RETURN to study:
(Required)
DD slash MM slash YYYY
Candidate’s Comment:
International students only – please include address and contact number if outside Australia. International student must update their address details with Imperial and DHA within 7 days of any change – this is a condition of all student visas.
International Student Leave of Absence Checklist:
(Required)
I am aware of the fee and visa implications for international students intending to take Leave of Absence
I am aware that I need to seek approval if I am planning undertaking international fieldwork as it may have fee or visa implications.
I have included with this application: certified medical certificates and supporting official documentation
I am aware that Confidential Advise and Counselling is available and that all international students are encouraged to speak to Student Support Services for confidential advice before making a final decision to apply for Leave of Absence on telephone 03 9417 4777
I am aware that International students on student visas can not remain in Australia during leave periods, however I can discuss this requirement if I contact Imperial at admissions@imperial.edu.au
SUPPORTING DOCUMENTATION ATTACHED
Max. file size: 100 MB.
Student’s Signature
Student’s Email Address:
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Online Forms
Application for Enrolment – Traffic Management
Application for Enrolment – Hospitality Courses
Appeal Form
Application for Award
Application for Change of Course – International
Application for Change of Course – Full Fee
Application for Leave of Absence Form
Application for record of participation
Application for Re-issue of Award or Statement of Attainment
Application for Release
Change of Contact Details
Complaint Form
Course Credit Transfer Application Form
Deferment/Suspension of Studies
Education Agent Application Form
Permission to obtain USI on student’s behalf
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