Fillable Leaveof Absence (Diablo Valley College)

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Leaveof Absence (Diablo Valley College)

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LEAVE OF ABSENCE REQUEST Date: ___________________
Note: Official Leave of Absence is limited to two weeks (10 school days) and will not be
granted until this petition is complete will all signatures. It is not necessary to file a Leave of
Absence request for illness.
Name: ____________________________ ID#: ________________________
I hereby petition to be granted a Leave of Absence from Diablo Valley College for the period
_________________ to ________________ due to the following emergency;
Name and Number of Course
Instructor’s Signature
Grade at
Time of Leave
_____________________________
I have discussed this petition with the student _________________________________
APPROVED: ________________________________
Notices sent to instructors: (date) ________________________
Signature of Student
Signature of Counselor
Signature of Vice President of Student Services
(Rev. 1/96)
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Leaveof Absence (Diablo Valley College)

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Completed 18 July 2020

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