Leave of Absence Form

Leave of Absence Form
This form is to be completed by international students who wish to apply for a leave of absence. A leave of absence will be granted in compassionate or compelling circumstances as per AICSE's Deferral, Suspension and Cancellation Policy and Procedure. Students are required to provide documentary evidence of such circumstances.

Your visa may be affected by your application so you should contact DHA on 131881 to discuss.
Name*

PrefixFirst NameMiddle NameLast Name
Student ID*
Gender*

MaleFemaleOther
Phone Number*

area codePhone Number
Email*
example@example.com
Course*
Group Number
Campus*
Campus*
Select your Campus
Leave From*

DayMonthYear
Leave Until

DayMonthYear
Reason for the leave of absence:*
You must attach SUPPORTING DOCUMENT.*

Browse Files

Cancelof
I have discussed the reasons for the leave of absence with the Student Support Officer*

YesNo
Have your contact details changed since you last advised us of them?*

YesNo
Current Residential Address*

Street Address

Street Address Line 2

CityState / Province

Post CodeCountry
Declaration:

I declare that to the best of my knowledge, the information supplied by me is true, correct and complete in every respect.

I acknowledge that the submission of false, incorrect, incomplete or misleading information may result in penalties as defined by the student support team and authorised officer.

I am aware that if I extend my course duration due to leave of absence, I may need to extend my eCoE, and my visa expires prior to the completion of the course, I will be required to apply for a new student visa to complete the study.
Signature*

Clear
Date

DayMonthYear
Should be Empty: