Request for Academic Leave of Absence

(휴학원)

Student ID		Name		School/Dept.
Degree Program	□ BS □ MS □ MS-PhD	Nationality		Type of Visa you possess
Address
Contract Info	Tel.: ( - - ) / H.P( - - )
Reason of Absence	□Military service □Personal Conditions -Illness - Studying -Studying abroad - Preparation for job/career -Etc.( )– Economic Reason
Period of Absence	From( mm/dd/yy) To( mm/dd/yy) - (for ___ Semesters)
Tuition Fees	□aid □ot paid

This request is submitted for permission of academic leave of absence as specified above.

Date:______________(MM/DD/YY)

Advisor	School Head	Applicant: (Signature)
Name:		Guardian: (Signature)

To the President of UNIST