Copy for: OCS, OUR & Student

Date: March 4, 2024

Prof. Maria Constancia O. Carrillo, PhD

Dean
College of Arts and Sciences
University of the Philippines Manila

Dear Dean Carrillo:

I, Uno Afable Cafe with Student Number 202317160 would like to apply for leave of absence from my degree

program/course in Bachelor of Science in Computer Science effective March 4, 2024 up to August 13, 2024

REASON/S FOR LOA: Due to recent diagnosis of Severe Depressive Disorder - which had been the cause of me missing my classes and
activities for more than 2 weeks already. I am very willing to provide my Medical Certificate as a proof document if needed.

Very truly yours, Noted by:

Note to the student:

1. Accomplish college clearance and secure certification from the Director of Student Affairs that you have no pending case. If the
leave of absence is due to sickness, please attach MEDICAL CLEARANCE from the UP Health Service.
2. If withdrawal is after ¾ of the semester/term, your instructor may give you a grade of “5” if your class standing up to the time
of withdrawal is failing.
3. NO leave of absence is permitted within two weeks from the last day of classes.

Note to the Instructor:

If the leave of absence is to be taken after the mid-semester period, which is on March 25, 2024, the instructor concerned is required
to indicate the class standing of the student at the time the leave is applied for.
Subject Class Instructor’s Subject Class Instructor’s
Count standing signature Count signature
enrolled enrolled standing

PE 1FPF
1 Arts 1 TFE 5
Asst. Prof. Celia M. Bonilla HCD2 Lorenzo M. David
Comm 10 Philo 1
2 6
TFC2 Assoc. Prof. Gina S. Salazar MHB Asst. Prof. Bernard N. Caslib Jr.
Ethics 1 Soc Sci 2
3 7
TFI Assoc. Prof. Ma. Paula G. Sioco TFB Beatrice A. Fernandez
NSTP
Nothing
4 CWTS 2 8
Follows
BSCS Carl Emmanuel B. Gonzales Nothing Follows

SCHOLASTIC STANDING as of the last semester: , AY :

☐ Good ☐ Probation ☐ Enrolled
☐ Warning ☐ Readmitted ☐ Not enrolled
CLEARANCE