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    Application For Leave of Absence (Loa)

    Uploaded by

    John Cena
    This document is an application for a leave of absence (LOA) from limited face-to-face in-campus classes and hospital duty/clinical experience. The student is requesting the LOA due to personal reasons and agrees to four conditions: returning within the approved period, informing the dean one month before intended return, potentially needing to shift programs or transfer schools if unable to return in the approved time, and not taking another LOA unless approved by the dean. The student lists the specific courses and details they are requesting the LOA for. Signatures are needed from the student, parent if a minor, level coordinator, dean, VPHE, and registrar to approve the LOA.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application For Leave of Absence (Loa)

    Uploaded by

    John Cena
    54 views1 page
    This document is an application for a leave of absence (LOA) from limited face-to-face in-campus classes and hospital duty/clinical experience. The student is requesting the LOA due to personal reasons and agrees to four conditions: returning within the approved period, informing the dean one month before intended return, potentially needing to shift programs or transfer schools if unable to return in the approved time, and not taking another LOA unless approved by the dean. The student lists the specific courses and details they are requesting the LOA for. Signatures are needed from the student, parent if a minor, level coordinator, dean, VPHE, and registrar to approve the LOA.

    Original Title

    4_LOA-Form

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    This document is an application for a leave of absence (LOA) from limited face-to-face in-campus classes and hospital duty/clinical experience. The student is requesting the LOA due to personal reasons and agrees to four conditions: returning within the approved period, informing the dean one month before intended return, potentially needing to shift programs or transfer schools if unable to return in the approved time, and not taking another LOA unless approved by the dean. The student lists the specific courses and details they are requesting the LOA for. Signatures are needed from the student, parent if a minor, level coordinator, dean, VPHE, and registrar to approve the LOA.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    54 views1 page

    Application For Leave of Absence (Loa)

    Uploaded by

    John Cena
    This document is an application for a leave of absence (LOA) from limited face-to-face in-campus classes and hospital duty/clinical experience. The student is requesting the LOA due to personal reasons and agrees to four conditions: returning within the approved period, informing the dean one month before intended return, potentially needing to shift programs or transfer schools if unable to return in the approved time, and not taking another LOA unless approved by the dean. The student lists the specific courses and details they are requesting the LOA for. Signatures are needed from the student, parent if a minor, level coordinator, dean, VPHE, and registrar to approve the LOA.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    APPLICATION for LEAVE OF ABSENCE (LOA)

    (from Limited Face-to-Face In-Campus Classes and Hospital Duty/ Clinical Experience)
    Date: ______________

    ID Number: _____________ Course &Year: ______________ Sem: ____ SY: ________


    Name: ____________________________________________________________
    Last, First Middle

    I hereby request for a leave of absence from the Limited Face-to-Face In-campus Classes and Hospital Duty due to
    __________________________________________________________ on the following conditions:

    1. I shall return within the period specified and approved by the dean to continue with RLE compliance.
    2. I shall write the dean to inform her about my intended return from LOA one (1) month prior to the
    semester of such return;
    3. If I cannot return within such specified and approved period, I may have to shift to another program or
    transfer to another school.
    4. I shall not invoke this option again when granted during my entire stay in the college unless approved by
    the dean.
    `
    I therefore request for Leave of Absence from LFF In-campus Classes and/or Hospital Duty/Clinical Experience from
    the following courses:

    Course & Section Days and Time Faculty/Level Coordinator


    1. ____________________ __________________ ___________________
    2. ____________________ __________________ ___________________
    3. ____________________ __________________ ___________________
    4. ____________________ __________________ ___________________
    5. ____________________ __________________ ___________________

    ____________________
    Student’s Signature
    _____________________
    Name of Parent and Signature
    (if student is a minor)
    Endorsed by:

    Level Coordinator: ________________________ Date: __________________


    Signature over printed name

    Approved Duration of LOA from LFF (to be filled up by the Dean)

    _________________________Sem SY to _________________________ Sem SY

    Approved by:

    Dean: __________________________________ Date: ________________

    Verified by:

    VPHE: ___________________________________ Date: ________________

    Validated by:

    Registrar: ________________________________ Date: _________________

    Xavier University, Corrales Avenue, Cagayan de Oro City, Philippines


    853-9800/loc 9446 (Sec) /loc 9450 (Evaluator) /loc 9449 (Skills Lab)

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