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LOA Template

The document is an application for leave of absence from the Nueva Vizcaya State University. It requests information from the student such as name, student number, degree program, and reason for leave. It also notes the effectivity and projected return term. Signatures are needed from school officials to approve or disapprove the application.

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sherwinmanzano009
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38 views

LOA Template

The document is an application for leave of absence from the Nueva Vizcaya State University. It requests information from the student such as name, student number, degree program, and reason for leave. It also notes the effectivity and projected return term. Signatures are needed from school officials to approve or disapprove the application.

Uploaded by

sherwinmanzano009
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

NUEVA VIZCAYA STATE UNIVERSITY


3702 Bambang, Nueva Vizcaya

APPLICATION FOR LEAVE OF ABSENCE


STUDENT INFORMATION

FULL NAME: _________________________________________________________ STUDENT NO.: _____________________


(Last, First, M.I., Extension if any)
E-mail Address: __________________________________________________ Contact No.: ____________________________
Degree Program: ___________________________ Year Level: ___________ College: ________________________________

Please check if you are a grantee of the following UniFAST Programs: TES TDP FHE

TES/TDP Award No. _______________________

LEAVE OF ABSENCE INFORMATION


Date of Filing: ______________________ Effectivity of LOA: _______ Sem/Term, AY 20____- 20____

REASON/S FOR LEAVE: ___________________________________________________________________________


___________________________________________________________________________
___________________________________________________________________________

Projected Sem/Term of Return:

1 st
Sem/Term  2nd Sem/Term 3 rd
Term/Summer AY 20____ - 20 ____

** For UniFAST Student grantees (if applicable):

I fully understand that my name will be delisted from the Master List of Beneficiaries if I fail to enroll in more than one
academic term within the academic year.

Signature Over Printed Name

SCHOOL OFFICIAL’S SIGNATURE


RECOMMENDATION: Approved ACTION: Approved
Disapproved Disapproved

[Signature Over Printed Name] [Signature Over Printed Name]


PROGRAM/DEPARTMENT HEAD DEAN

Noted by:

RAMIR R. HONGO
[Signature Over Printed Name]
REGISTRAR III
REMARKS:

Note:
1. This is a LOA template that may be modified to suit HEI’s institutional policies on admission and retention.
2. HEIs with an institutional policy and available LOA template need not use this suggested template.

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