RR-8

THE HONG KONG UNIVERSITY OF SCIENCE & TECHNOLOGY Admissions, Registration & Records Office

Application for Leave from Study

( for Undergraduate Students )
Notes
1. 2. Application for leave from study of a semester should be made prior to the beginning of that semester. The leave period should commence at the beginning of a semester unless under exceptional circumstances such as poor health. Request for leave from study for two consecutive semesters requires approval of the relevant Dean. Leave from study for more than two consecutive semesters will normally not be considered. Any exceptions to this policy require the approval of the Office of the Provost. Application for leave in the current semester submitted falls short of two weeks prior to the commencement of the examination period will normally not be accepted. Approved leave from study will not count towards the time limit on program completion. Tuition fee paid for the semester for which leave from study is approved is not refundable or transferable. Upon resumption of study after the approved leave period, a student must be officially registered in the program in the semester when he/she is considered for graduation from that program.

3. 4. 5. 6.

Application Procedures
1. Undergraduate students who wish to take leave from study should complete Sections I & II below, and submit the form with appropriate supporting documents to the program department for approval.
2.

Students will be notified of the result of the application by ARRO.

I.

Student Particulars
Student Name :
(In English)

Student No. : Year of Study :

Program of Study : Contact Telephone No. :

II. Application Details

Period of Leave from Study : From To Expected Time of Resumption of Study : Reason for Leave from Study [please tick as appropriate] Semester, 20____ - 20____ Semester, 20____ - 20____ Semester, 20____ - 20____

a. b. c. d. e. f.

Employment Financial hardship (please approach SAO for assistance if necessary) Health ( medical certificate enclosed, if any) Heavy academic workload Joining internship or co-op program Others (please specify) :

Have you previously been granted leave from study ?

YES

NO

If yes, please state the leave period : __________________________________________________________ I declare that all the information given above is true and correct to the best of my knowledge.

Signature of Student

Date

III. Decision of Program Department

The application is Effective Date of Leave : approved not approved Year of Study upon Return :

[Please pass this Form to the Deans office for endorsement if the period of leave from study is for two or more consecutive semesters.]

Signature of Department Head/ UG Coordinator

Name

Date

IV. Endorsement of Deans Office

I endorse do not endorse the application as approved by the Program Department in Section III.

Signature of Dean

Name

Date

[Please note that application for leave from study for more than two consecutive semesters should be directed to the Office of the Provost for approval.]

V.

Admissions, Registration & Records Office Use Only

Study to be Resumed in :

Result Received On by

Student Notified on

Computer Record Updated by on

Remarks :

RR-8 (03/ 2011)