Student Leave of Absence Application
I understand that I will be notified of the approval or denial of this application via my student email account. I understand that I am limited to three, 5-day increments of leave per academic year, that the minimum is three days, but that each use results in at least one, 5-day increment used. I understand that if my request is approved for more than five days, I will use more than one 5-day increment. I understand that if I am approved leave from a defined date course, I am obligated to the required coursework I may miss.
Name
*
First Name
Last Name
Student ID
*
Student Program
*
EMT
Advanced EMT
Automotive Technician
Culinary Arts
Electrical Apprenticeship
Automation Technology
Information Technology
Medical Clinical Assistant
Medical Office Receptionist
Nursing Assistant
Phlebotomy
Plumbing Apprenticeship
Practical Nursing
Production Welder
Professional Truck Driving
Software Development
Welding Essentials
Pharmacy Technician
Student Course
*
First Date of leave Requested
*
-
Month
-
Day
Year
Date
Last Date of Leave Requested
*
-
Month
-
Day
Year
Date
Planned Return Date
*
-
Month
-
Day
Year
Date
Reason for Leave Requested
*
Student Signature
*
Submit
Should be Empty: