Mary Immaculate College Student Services

Application for Leave of Absence (Undergraduate Only)

You are asked to take note of the regulations governing the operation of Leave of Absence as outlined overleaf.

Student Name: _________________________________Student ID:_______________________

(Block Capitals) Address_________________________________________________________________________ Mobile Number:_________________________ Email: _________________________ Current Programme:___________________________Year of Study: ____________________

(Title) Stated Period of Requested Leave From: _______________________________To:____________________________ Are you in receipt of Grant/Scholarship: YES NO (delete as appropriate) Please state Reasons for Request: _____________________________________________________________________________ _______________________________________________________________________________ Student Signature: Date:____________________________ Dean’s Signature (Arts/Education): _____________________________ If you wish you may request the Student Counsellor to comment confidentially on your application. Otherwise submit this form to the Student Services Office directly (Room 112 – Foundation Building). You may be required to attend a Student Status Committee meeting to discuss your application. The schedule of meetings is available from the Student Services Office.

Part 11: Counsellors Comments (Where Required) ____________________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ Counsellor’s Signature: Date:_________________________

Please submit to Student Services (Room 112 – Foundation Building)

Part 111: Student Status Committee Comments/Recommendations

If Leave is granted please state: Period of Leave: From: To:_______________________ Year of Study on Re-entry:______________________________________________ Term of Re-entry:_____________________________________________________ Comments:___________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ Chairman’s Signature: Date:____________________ Notes: An application for leave of absence will be considered for a student who has completed at least one term at Mary Immaculate College and who is in good standing. Leave of absence can be granted for a full semester or a full academic year. A student who is on leave of absence is not a registered student of the College and must therefore forfeit any grant/scholarship for the period of the leave. Such grants/scholarships are normally renewed when the student resumes his/her studies. The College will inform the Grant/Scholarship Authority if a student is granted leave, and will request renewal of the award when the student resumes his/her studies.