leave of absence - camelot college-short term job …€¦ · · 2012-08-23leave of absence...
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2618 Wooddale Blvd., Ste A • Baton Rouge, LA 70805 • (225) 928-3005 • fax. (225) 927-3794www.camelotcollege.com
LEAVE OF ABSENCE REQUEST
I am requesting a leave of absence from Camelot College beginning____________________. I will return to school on ______________________. Iunderstand that this leave of absence may not exceed 180 days and that I will notincur any additional tuition charges during the leave of absence. I also understandthat in the event I do not return from the leave of absence, any refunds due will bemade to the appropriate financial aid programs within in 30 days, in addition therepayment on my student loans will begin immediately.
Reason for this request:
________________________________ ______________Student’s Name (Print last name and first) Date
________________________________Student’s Signature
________________________________Student’s Social Security Number
INSTITUTIONAL USE ONLY
This leave of absence is approved.
___________________________________ ________________Signature of Institutional Official Date