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Leave of absence
Enrolment and Student Records | Leave of absence 0865 0420 | 1 of 1
This form is only for research candidates appling for leave of absence.
Section A – Personal information
RMIT student number Date of birth (DD/MM/YYYY) Contact tel.
Given name/s
Family name
Section B – Program information
Program name
Program code Campus
Leave from (DD/MM/YYYY) to (DD/MM/YYYY)
Section C – Reason for applying for leave of absence (tick one box only)
Academic difficulties Dissatisfaction with program Support difficulties Financial hardship
Work commitments Family commitments Medical Personal
Parental leave National service Other
Section D – Are you receiving a scholarship or sponsorship?
No Yes If yes, name of scholarship or sponsorship
Section E – Student declaration
I understand the following in apply for this leave of absence:
1. After my leave ends, I am responsible for enrolling for the next semester/term by the relevant enrolment deadline.
2. I understand that I must provide supporting documentation e.g. medical certificate.
3. RMIT may contact the issuer of any relevant certificates for validation purposes.
I accept these terms and wish to apply for leave of absence from the above program.
Student signature Date
(DD/MM/YYYY)
Section F – School and supervisor authorisation
School authorisation
Leave of absence is granted: Yes No
Authorised senior supervisor signature Date (DD/MM/YYYY)
Authorised officer signature Date (DD/MM/YYYY)
Section G – International onshore students only
International compliance
Leave of absence is granted (subject to school approval): Yes No
Authorised officer signature Date (DD/MM/YYYY)
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