(1) To the Dean of School…………………………………………………………..
Name Mr/ Miss/ Mrs…………………………………………………………………………...…………Student ID
Study in School of………………………………………………………………Program of……………………………………………………………Mobile phone………………………………………
Request for leave of absence for 1 From semester…………………. Academic year……………………..
2 To semester…………………….. Academic year………………………
Reasons for on leave
Illness with a document and the name of a medical provider…………………………………………………………………………………………….
Other reasons (indicate)………………………………………………………………………………………………………………………………………………………….
Documents…………………………………………………………………………………………………………………………………………………………………………………
For your consideration
(2) Advisor's Comment (3) Dean's Comment
……………………………………………………………………………… ………………………………………………………………………………
……………………………………………………………………………… ………………………………………………………………………………
Signature Signature
(4) Committee's conclusion
Approved Disapproved ………………………………………………………………………………
………………………………………………………………………………
Signature Signature
Already paid…………………. Baht Recorded
Already registrered for this semester
Signature
(Please read the information on the back of this sheet before filing a request.)
…………/……………/………… …………/……………/…………
…………………………………………………… ……………………………………………………
(………………………………………………) (Mr.Ruangsak Kiengkamon)
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(6) Recorded by Division of Registrar 's staff
(………………………………………………)
……………………………………………………
15/12/2014
(………………………………………………) (………………………………………………)
…………/……………/………… …………/……………/…………
(5) Head of Division of Registrar's Comment
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…………………………………………………… ……………………………………………………
(………………………………………………)
Semester First Second Summer Academic year…………………….
Number…………………………………………………………………………………. Date……………………………………………………………………………………….
Student's Signature
DIVISION OF REGISTRAR, MAE FAH LUANG UNIVERSITY
Request Form for Leave of Absence
Semester
………………………………………………………
The Division of Registrar
No……..................….…………….
Time…….…..Recorded by………..
Mae Fah Luang University
Date.......…........….…….………….
School of ........................................
No……..................….…………….
Time…….…..Recorded by………..
Mae Fah Luang University
Date.......…........….…….………….
Student level
Undergraduate student
Graduate student
A current student who fails to enroll within the university's enrollment period must request a official leave, as stipulated
by Clause 18 of Mae Fah Luang University Rules for Bachelor's Degree Education, BE 2542(1999), and must pay the studentship
retention fee, so as to retain his/her studentship. The following conditions apply.
1. The student may request an official leave for one or more of the following reasons.
1.1 Being conscripted into the military ;
1.2 Being granted an international exchange programme scholarship or any other scholarship that
the university considers worth supporting ;
1.3 Being so ill or receiving so serious accident-related injury that the physician has ordered a recuperation
period equal to more than 20 percent of the entire study time, in which case the student must submit a medical
certificate issued by a state or private hospital approved by the Ministry of Public Health; and
1.4 A personal affair, on the condition that the student has studied at Mae Fah Luang University for at least
one semester and has a minimum GPAX of 2.00.
2. When the student has an urgent need to request a leave, the student must submit a request to the Dean as soon as
possible. His/her request shall then be considered by the committee of the School to which the student belongs.
1. A student must first seek his/her advisor's consent and submit a leave request to the Dean for one or more of the
following reasons.
1.1 Being granted an international exchange programme scholarship or any other scholarship that
the university considers worth supporting ;
1.2 Being so ill or receiving so serious accident-related injury that the physician has ordered a recuperation
period equal to more than 20 percent of the entire study time, in which case the student must submit a medical
certificate issued by a state or private hospital approved by the Ministry of Public Health; and
1.3 A personal affair, on the condition that the student has studied at Mae Fah Luang University for at least
one semester and has a minimum GPAX of 3.00.
A request submitted by a plan(1) student, however, shall be considered by the School committee and
approved by the Dean.
2. When the student has an urgent need to request a leave, the student must submit a request to the Dean as soon as
possible. His/her request shall then be considered by the committee and approved by the Dean.
Notes :
1. Each granted leave shall not exceed two semesters. If a student needs to extend his/her leave, s/he must submit
another request and pay the studentship retention fee, unless s/he had paid his/her tuition.
2. To return to study, an on-leave student must submit a request to the Dean at least one week before the regular
enrollment period of each semester.
Student's Signature
Leave Conditions
Bachelor Degree
Graduate Level
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(………………………………………………)
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