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Download Application for Leave of Absence - University of August 2015 Application for Leave of Absence Students may be granted an approved Leave of Absence for personal, health or other reason

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  • Revised August 2015

    Application for Leave of Absence Students may be granted an approved Leave of Absence for personal, health or other reasons which temporarily prevent continuation in the graduate program as a full-time, part-time, or continuing student. During a leave of absence approved by the Graduate Studies Committee, students shall not be required to register or pay fees. In addition, they would not be engaging in research, thesis work or any academic activities. The Leave of Absence is normally granted up to a maximum of one year. Student Name: _________________________________ Student Number: ________________________

    Permanent Address: ____________________________________________________________________

    Email: ________________________________________

    Graduate Program Advisor / Supervisor: ____________________________________________________

    Program of Study: _____________________________________________________________________

    Full-time Part-time Have you had a previous leave? No Yes- if yes, list all prior leaves From: To: From: To: From: To: Except for parental leave or in exceptional circumstances, it is not expected that a student will be granted more than one leave during their time in the graduate program. Request for Leave: From January 1 May 1 September 1 Year ________

    Until December 31 April 30 August 31 Year________ Type of Leave Requested: Parental Leave (proof of pregnancy birth/adoption or physicians report) Medical Leave (physicians report) Compassionate Leave (written explanation of circumstances) Are you currently receiving awards, stipends and/or funding for the duration of the leave requested? No Yes if yes, please list and provide amounts of all awards, stipends and/or funding so that we may facilitate the accurate administration of these funds prior to and upon return from your leave.

  • Revised August 2015

    By signing this form, I confirm that I have read the Leave of Absence in the Graduate Studies Policy Document and understand the conditions of this request and agree not to undertake any academic work toward my graduate degree program. Student Signature: _________________________________Date: ________________________________

    Graduate Program Advisor Signature: _______________________________Date: ___________________

    Graduate Program Chair Signature: _________________________________Date: ___________________

    Submit all documentation to the Office of the Faculty of Graduate Studies, 1BC06, (204) 786-9797.

    Dean of Graduate Studies: ____________________________Date: ________________________________

    Office Use Only Leave granted from ______________________ to _____________________

    Leave denied

    New deadline for completion of degree requirements _________________________________

    Approved by: __________________________________________________________________

    Withdrawn from courses during Leave of Absence

    Coordinator, Student Records (Graduate Studies) Signature: __________________________________________

    Rationale for Decision:

    ___________________________________________________________________________________________

    ___________________________________________________________________________________________

    ___________________________________________________________________________________________

    ___________________________________________________________________________________________

    ___________________________________________________________________________________________

    Student Name: Student Number: Permanent Address: Email: Graduate Program Advisor Supervisor: Program of Study: Fulltime: Parttime: No: Yesif yes list all prior leaves: From: To: From_2: To_2: From_3: To_3: January 1: May 1: September 1: Year: December 31: April 30: August 31: Year_2: Parental Leave proof of pregnancy birthadoption or physicians report: Medical Leave physicians report: Compassionate Leave written explanation of circumstances: No_2: Yes if yes please list and provide amounts of all awards stipends andor funding so that we: Date: Date_2: Date_3: Dean of Graduate Studies 1: Dean of Graduate Studies 2: Date_4: undefined: to: Leave granted from: Leave denied: New deadline for completion of degree requirements: Approved by: Withdrawn from courses during Leave of Absence: Rationale for Decision 1: Rationale for Decision 2: Rationale for Decision 3: Rationale for Decision 4: Rationale for Decision 5:

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