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Application For Leave of Absence (Loa) Form: Office of The University Registrar

This document is an application form for students at the University of the Philippines Open University to apply for a leave of absence. It requests the student's name, student number, program, major, term of effectivity, reason for leave, and signature. It notes that a leave of absence cannot exceed one year and includes a section for faculty to indicate the student's class standing in current subjects before approving the application.

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jeivela25
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23 views

Application For Leave of Absence (Loa) Form: Office of The University Registrar

This document is an application form for students at the University of the Philippines Open University to apply for a leave of absence. It requests the student's name, student number, program, major, term of effectivity, reason for leave, and signature. It notes that a leave of absence cannot exceed one year and includes a section for faculty to indicate the student's class standing in current subjects before approving the application.

Uploaded by

jeivela25
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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OUR Revised LOA Form March 2018

UNIVERSITY OF THE PHILIPPINES OPEN UNIVERSITY


Office of the University Registrar

APPLICATION FOR LEAVE OF ABSENCE (LOA) FORM

NAME OF STUDENT: STUDENT NUMBER:

PROGRAM: MAJOR: (if applicable)

TERM OF EFFECTIVITY:

REASON FOR FILING:

LOA FEE PAID UNDER OR # _______________


DATED _________ IN THE AMOUNT OF ______ _________________________________
SIGNATURE OF STUDENT

Noted:
_________________________ _______
Faculty Secretary Date

IMPORTANT: LOA must not exceed one year from the term of effectivity.

DO NOT FILL THIS PORTION


……………………………………………………………………………………………………………………………………………………..
NOTE TO THE FACULTY-IN-CHARGE: If the application for Leave of Absence is filed after the 2nd tutorial (for a 4-study
session) or the 3rd tutorial (for a 5-study session), you must indicate the standing of the student at the time the leave is
applied for. After filling up this portion, please submit this to the Office of the Faculty Dean.

Subjects Enrolled in Class Standing FIC’s Signature


(Passing or Failing)

1.

2.

3.

4.

APPROVED:

________________________________ _______
DEAN DATE

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