Toloa Leave Form

Academic Impact Acknowledgement

I understand that taking an extended Leave of Absence may affect my: • enrolment status • scholarship/sponsorship • graduation timeline • access to university services
I understand that I may be required to re-enrol before returning to study

Visa Permit (if applicable)

Please skip to the next section if you are a local student

I have checked the status of my permit / permit requirements.

Permit Status

Provide Details About Your Permit

You must attach your permit status with your leave request

Single Line Text

Approval not House

List Your Dependants and Their Permit Status:

Student Declaration

I confirm that the information provided in this application is true and correct.

Student Signature

Clear Signature

Date / Time

Date

Time

Supervisor / Head of School Approval

*Research students require supervisor approval *Head of School Signature is required by all students NOTE: Your application for leave is only approved once Head of School Approval and Signature has been given. Once you submit this form, it will be forwarded to the relevant staff to ask for approval.

I acknowledge that this form is only approved, once I have received written confirmation from the Academic Dean's Office. Until you receive approval, your request has not been approved.

Yes I acknowledge

Student Details

Leave of Absence Details

Academic Impact Acknowledgement

Visa Permit (if applicable)

Student Declaration

Supervisor / Head of School Approval

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