Application for Leave of Absence Form

Personal Detail

First Name(Required)

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 Country

Telephone(Required)

Email Address(Required)

International Student

Yes

The first study day LEAVE i to take effect from:(Required)

The first study day of RETURN to study:(Required)

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:

CAPTCHA

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Online Forms

Application for Leave of Absence Form

Application for Leave of Absence Form

Personal Detail

Online Forms