Application for Special Leave Form

Application for Special Leave Form
Instructions
Please complete this form to apply for Special Leave outside the designated holiday periods. Refer to the Special Consideration Policy and the Deferment, Suspension, and Cancellation Policy on the College’s website. Applications will be processed within 10 working days after receipt. You can also email the completed form to enrolments@rosehillcollege.edu.au, or contact the Admin Manager at info@rosehillcollege.edu.au for assistance.
1. Student Details
Full name*
Student ID*
Course Name*
Intake Date

MonthDayYear
Date
2. Special Consideration Details
Reasons for Leave Application (tick the appropriate box)*

MedicalFamilyPersonalCriminalMisadventureOther (please specify)
Duration of Leave Applied
Leave starts from

MonthDayYear
Date
to

MonthDayYear
Date
Number of days
Short Summary of the Reasons for Special Leave
Supporting Documents

(Attach evidence from an independent authority that supports your application, e.g., Medical Practitioner’s prescription, flight tickets, etc.)
Cancelof
3. Student Declaration
- I have read and understood the Special Consideration Policy and the Deferment, Suspension, and Cancellation Policy provided by the College.
- I understand that the approval of Special Leave may lead to changes in my enrolment and payment schedule.
- I acknowledge that the application and evidence attached are complete and true. Any incorrect information will delay the processing of the application.
Student’s Signature*

Clear
Date*

MonthDayYear
Date

Office Use Only
Outcome

ApprovedNot Approved
Comments/Reasons:
Processed by:
Position:
Signature

Clear
Date

MonthDayYear
Date
Should be Empty:

Application for Special Leave Form

1. Student Details

2. Special Consideration Details

3. Student Declaration