ST.

VINCENT AND THE GRENADINES COMMUNITY COLLEGE

REQUEST FOR LEAVE OF ABSENCE
Read the information before completing this form.

STUDENT INFORMATION

Name: ______________________________________________________________________ SVGCC ID: ___________________________

(First Name, Middle Initial, Last Name)

Email Address: _____________________________________________________ Contact #: _______________________________

Division: DASGS DNE DTE DTVE

Programme of Study: _______________________________________________________________________________

LEAVE OF ABSENCE DETAILS

Reason for leave of absence: Medical Personal Other

In the space below, please provide an explanation (accompanied by any supporting documentation if
relevant):
_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Leave of Absence period: From DD / MM / YY To DD / MM / YY

Signature: ____________________________________________ ________ Date: ____________________________________

Students are expected to notify the Divisional Dean/Registrar at the end of their leave of absence that they wish to resume their
studies.

FOR OFFICIAL USE ONLY

Form Received by: ____________________________________Date: DD/MM /YY Signature: __________________________

Deferral of Acceptance: Approved Not Approved

Approved by: _________________________________ Date: DD/ MM/ YY Signature: _____________________________

Registrar Registrar
Registry, Registrar’s Office, SVGCC, P.O. Box 829, Telephone: 457 4503 Ext. 369