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LEAVE OF ABSENCE FORM:

1.    Student Name: ____________________________________
2.    Student ID: _____________________________________
3.    Diploma or Degree Program: _____________________________________
4.    The TDLI review committee must review all Leave of Absence requests before any time may be granted off. Please the following information to the Institute, review the information, the conditions, and return the form, with your signature and date and return to The Trafalgar Distance Learning Institute via EXPIDITED registered mail, you may fax, but you must follow up by sending a registered urgent letter mail for your file.
5.    Length of Time Requested For Leave: _____________________________________
6.    Term: ______________ Year: ___________
7.     Please provide the reasons for your request for leave of absence, please provide, accompanying documents, such as doctors notes, etc.. to substantiate your claim: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
8.    PLEASE READ: INSTITUE POLICY ON LEAVE OF ABSENCE REQUESTS:
9.    Students may request a leave of absence from the institute do to personal, medical, or emergency circumstances while they are enrolled in their particular semester. The leave of absence will become effective the date it is approved, and will last for 6 months, unless the student initiates reinstatement.

Students Signature: _____________________________________________

Date:


Student Services Officer Signature:
_____________________________________________

Date of Approval:


Office Approval:  Approved: ____ Denied: ____

Reason: _________________________________

Presidents Signature: ______________________

Date: ___________________________________

END OF LEAVE OF ABSENCE FORM.