USCoHospitaltiy Leave of Absence Form

Leave of Absence Form
Student Details
Name*
Student ID*
Phone Number
Format: (000) 000-0000.
Email*
example@example.com
Course/Group
Leave Request
NOTE: Your requested leave of absence MAY NOT EXCEED TWO CALENDAR WEEKS in a designated study period. If compassionate or compelling circumstances require you to take a longer leave, you must submit a Deferral and Allowable Suspension of Studies form.
Leave Request Period (Start Date)*

DayMonthYear
Date
Leave Request Period (End Date)*

DayMonthYear
Date
Total Number of Days
Reasons for taking Leave (please provide as much details as possible)*
Note: Attach any supporting documents with this form as applicable

Cancelof
Signed*

Clear
Date*

DayMonthYear
Date
Should be Empty:

Leave of Absence Form