APPLICATION FOR LEAVE OF ABSENCE

Please use BLOCK/CAPITAL letters, Post or hand deliver completed form to the Student Administration Office:
STUDENT ADMINISTRATION 32 Mouat St (PO Box 1225), Fremantle, Western Australia 6959

STUDENT DETAILS This Section Must Be Completed

Student Identification Number:

TITLE e.g. Mr/Ms/Mrs SURNAME/FAMILY NAME GIVEN NAMES

Mr
Contact Phone Numbers: Home: Work:

Mobile: Email:

Course Name:
Master of Theology (by Research)
(to which leave applies)

School: Philosophy and Theology (Home) Campus: Sydney

Are you an Overseas Student? YES (please circle one) Student Visa / Other Visa (please specify): _________________
✔ NO
Overseas students are not permitted to take leave from their studies unless there are exceptional circumstances and must have both the
approval of the Registrar (or delegate) and the Dean (or delegate) of their School. It is the studentʼs responsibility to ensure they have
received advice from DIAC regarding their visa and ensure they meet all visa conditions.
Do you hold a Scholarship? YES (please specify all) _________________________________________________
✔ NO
A student who holds a Scholarship (of any type) is responsible for ensuring they have approval to defer/have leave from the scholarship
and have met the terms and conditions of the scholarship(s) before applying for leave. Failure to meet scholarship terms and conditions
may result in the scholarship being revoked.
Are you registered under the Elite Athlete Program? YES ✔ NO

REQUEST FOR LEAVE

Period of Leave requested: FROM: Semester ____ Year 20___ TO: Semester ____ Year 20___
1 19 1 19
Return to Studies: I intend to return to study in: 2 Year 20___
Semester _____ 19
Note: You will be required to reenrol in units when you return after leave and may require an appointment
with your Course Coordinator to discuss your study plans. Overseas students will require an Intervention
Strategy when they return from leave.

Unit enrolment: Yes ✔ I wish to withdraw from all current units

Note: You will be withdrawn from any units you are enrolled in for future terms and/or semesters. You
are still liable for the fees for these units if withdrawal occurs after the Census Date of the unit(s).
You will receive a Fail grade if withdrawal occurs after the Academic Penalty Date of the unit(s).
No I do not wish to withdraw from all current units
REASONS FOR LEAVE -- attach separate pages if required

1) I must take four weeks off to care for my two young children while my wife does her
teaching prac.
2) We are expecting our third child later this year.
3) We plan to move interstate in June.
4) We will be attending two weddings interstate. Budget constraints mean we must drive.

I declare the information provided on this application and in supporting documentation is true and complete and I have attached
supporting documentation where required. I have read and understand the Universityʼs General Regulations, relevant School
and Course Regulations regarding Leave of Absence including the guidelines on the reverse of this form. I understand the
consequences of taking leave from my studies and accept responsibility to ensure that my enrolment is correct. I have sought
appropriate academic and immigration advice (where relevant) before completing this request for leave. I agree to check my
Notre Dame Student email account for important information that may be sent to me whilst I am on leave.

Student Signature: Date:

SIGNATURES OF APPROVAL
Dean of School (or delegate): Date:
Registrar (or delegate):
Date:
– for Overseas Students
The University of Notre Dame Australia • 32 Mouat Street (PO Box 1225), Fremantle, Western Australia 6160
Tel: +61 8 9433 0555 • Fax: +61 8 9433 0544 • email: [email protected] • www.nd.edu.au • CRICOS CODE: 01032F

Last updated: 18/02/19

 LEAVE OF ABSENCE GUIDELINES – PLEASE READ CAREFULLY
WHERE TO LODGE THIS FORM
This form should be submitted to your School for approval then submitted to the Student Administration Office. It is your responsibility to make sure this form is
received by Student Administration and by any relevant deadlines.

DATE OF EFFECT
Changes will be effected from the date your form is signed by the Dean of your School (or delegate). You should ensure that the form is received before any
relevant deadlines.

PROOF OF LODGEMENT
If you mail the form and require proof of lodgement you should send it by Registered mail. It is your responsibility to ensure you keep a copy as proof of
lodgement if required.

APPROVAL
All applications for leave of absence require approval by your School and for overseas students, the approval of the Registrar (or delegate). The University will
notify you of any amendments to your enrolment or changes which have not been approved. Submitting a form does not guarantee approval.

WITHDRAWAL FROM UNITS

If you withdraw from a unit(s) after the Census Date (Financial Penalty Date) you will still be responsible for payment of the fees for that unit(s) and may
receive a Withdrawal with Fail (“WF”) grade if withdrawal is after the Academic Penalty Date for the unit(s). It is your responsibility to ensure you have
withdrawn using the appropriate form and by the published withdrawal without penalty dates.

PERIODS OF LEAVE OF ABSENCE AND MAXIMUM DURATION

A student is entitled to a maximum of four (4) semesters leave of absence from their studies at the University in accordance with General Regulations. Where a
student seeks more than four (4) semesters leave, the student may be required to withdraw from the University and apply in writing to the Provost for
readmission when they wish to return to their studies. Leave of absence is counted towards the maximum duration permitted for a course. You should discuss
your courseʼs maximum duration with your Course Coordinator before you take leave.

EXTENDING YOUR LEAVE OF ABSENCE OR RETURNING TO STUDIES

It is your responsibility to inform the University of your intention to either apply for further leave from your studies or to reenrol. If you wish to extend your leave
of absence, you must complete another application for leave and submit it for approval before the end of your current period of leave; otherwise you may be
recorded as absent without leave (“AWOL”). If you wish to reenrol after your approved period of leave, you must contact your School for reenrolment dates,
requirements and deadlines.

UNITS ON HOLD (“H”) OR IN PROGRESS (“IP”)

If you take leave from your studies and have any units/outstanding pieces of assessment on hold or in progress you are required to complete the units and/or
pieces of assessments within the timeframes permitted for results on hold or in progress (refer General Regulations). It is your responsibility to ensure you have
discussed your leave and units/assessments on hold or in progress with your Course Coordinator before you take leave. Failure to complete
units/assessments may result in a fail grade for the units.

SCHOLARSHIP HOLDERS / EXTERNAL BODY SUPPORT

It is your responsibility to investigate the consequences that taking a Leave of Absence may have on any scholarship you hold (either from the University or
from an external body), including any external bodies for example impact on Centrelink benefits.

OVERSEAS STUDENTS
Overseas students are not permitted to take leave from their studies unless there are exceptional circumstances (in accordance with the National Code of
Practice Standard 13) which can be supported by independent documentation. If you are granted leave, the University is required to notify the Department of
Immigration & Border Protection (DIBP) of the changes in your enrolment. If leave of absence changes the expected duration of your course you will need to
request an extension of your CoE (Confirmation of Enrolment) from the University and may need to renew your student visa with DIBP before it expires if an
extension is required. Overseas students should be aware there are fee and visa implications for taking leave of absence (including but not limited to, late unit
withdrawal with penalty, visa extension and application fees, medical costs and so on). Overseas students must inform the University of any change of address
within seven days otherwise you are in breach of your student visa conditions. Overseas students must submit:
- Copy of passport (identification page)
- Copy of visa
- Original or certified copies of supporting evidence

INCOMPLETE APPLICATIONS AND PROVIDING FALSE/MISLEADING INFORMATION

It is your responsibility to ensure you have provided all information required as part of an application for leave. Applications may be refused or delayed where
insufficient information is provided or information requested is not received. The University may revoke an approved Leave of Absence should you provide any
information that is false or misleading.

UNIVERSITY REGULATIONS, POLICIES AND GUIDELINES

Your rights and responsibilities as a student of The University of Notre Dame Australia are outlined in the General Regulations, School and Course
Regulations, University Policies and Guidelines which can be viewed at: www.nd.edu.au. It is your responsibility to ensure you have read and understood what
is required of you as a student of the University.

Privacy Statement: The information provided in this form will only be used for the administrative or educational purposes of the University, or in accordance with
your specific consent. The University will not disclose your personal information to a third party unless required to or permitted by law or where you have consented
to the disclosure. Information relating to how the University collects, uses or discloses your personal information and how you may complain about the Universityʼs
handling of your personal information is contained in the Universityʼs Privacy Policy at: http://www.nd.edu.au/copyright.shtml#Privacy.

You have a right to access your personal information that the University holds about you and to seek its correction. If you wish to access your personal
information or inquire about the handling of your personal information, please contact the relevant Campus Registrar via email [email protected]

OFFICE USE ONLY

ı LOA periods already taken prior to this request plus LOA periods for this request does not exceed four semesters: ı yes ı no - returned to School
ı Student and School advised of decision email sent: _____/_____/_____ Initials of actioning officer: _________
ı LOA recorded in Maze: ı status changed ı LOA entered in quick units ı course notes made Initials of actioning officer: _________
ı Application and supporting documentation filed

For Overseas students: ı Registrar’s (or delegate) approval received ı Copy of passport (Identification page) received
ı Copy of visa received ı Original/certified copies of supporting evidence received
ı PRISMS updated and course note made in Maze: _____/_____/_____ Initials of actioning officer: _________

The University of Notre Dame Australia • 32 Mouat Street (PO Box 1225), Fremantle, Western Australia 6160
Tel: +61 8 9433 0555 • Fax: +61 8 9433 0544 • email: [email protected] • www.nd.edu.au • CRICOS CODE: 01032F

Last updated: 18/02/19