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    Application For Leave of Absence (Loa) : Program Adviser Department Chair Director of UG/G Program

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    dyrandz
    The document outlines the process for a student at the University of the Philippines Diliman to apply for a leave of absence, including securing signatures of approval from their program adviser, department chair, and dean, as well as paying a fee. It provides the application form to be filled out in triplicate, listing the period and reason for leave, and steps the student must follow to file for leave of absence.

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    Application For Leave of Absence (Loa) : Program Adviser Department Chair Director of UG/G Program

    Uploaded by

    dyrandz
    74 views2 pages
    The document outlines the process for a student at the University of the Philippines Diliman to apply for a leave of absence, including securing signatures of approval from their program adviser, department chair, and dean, as well as paying a fee. It provides the application form to be filled out in triplicate, listing the period and reason for leave, and steps the student must follow to file for leave of absence.

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    loa form

    Original Title

    Loa

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    The document outlines the process for a student at the University of the Philippines Diliman to apply for a leave of absence, including securing signatures of approval from their program adviser, department chair, and dean, as well as paying a fee. It provides the application form to be filled out in triplicate, listing the period and reason for leave, and steps the student must follow to file for leave of absence.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    74 views2 pages

    Application For Leave of Absence (Loa) : Program Adviser Department Chair Director of UG/G Program

    Uploaded by

    dyrandz
    The document outlines the process for a student at the University of the Philippines Diliman to apply for a leave of absence, including securing signatures of approval from their program adviser, department chair, and dean, as well as paying a fee. It provides the application form to be filled out in triplicate, listing the period and reason for leave, and steps the student must follow to file for leave of absence.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 2

    TO BE ACCOMPLISHED IN TRIPLICATE ( 1 COPY EACH FOR STUDENT, OUR and COLLEGE)

    UNIVERSITY OF THE PHILIPPINES DILIMAN

    APPLICATION FOR LEAVE OF ABSENCE (LOA)

    Period applied for : _____________________________________________________________________


    Reason(s) : _____________________________________________________________________
    _____________________________________________________________________

    ____________________________________
    Signature over Printed Name of Student

    Conforme: _____________________________ Student No. __________________________


    Signature of Printed Name of AY_____________ Course _____________
    Parent/Guardian
    Date: _______________________ Date: _______________________

    CLEARANCE SHOULD BE OBTAINED FIRST BY THE STUDENT IN THE OFFICES MENTIONED BELOW:

    CLEARED BY: DATE CLEARED BY: DATE


    COLLEGE ____________ __________ SDT ____________ __________
    COLLEGE LIBRARY ____________ __________ STUDENT LOAN BOARD ____________ __________
    DORMITORY ____________ __________ UNIVERSITY LIBRARY ____________ __________

    If LOA is availed during the second half of the semester, instructors should indicate the class standing of the student
    (Passing or Failing).

    CLASS CODE COURSE NO. SECTION CLASS STANDING INSTRUCTOR’S SIGNATURE DATE
    ____________ __________ ________ ________________ _______________________ __________
    ____________ __________ ________ ________________ _______________________ __________
    ____________ __________ ________ ________________ _______________________ __________
    ____________ __________ ________ ________________ _______________________ __________
    ____________ __________ ________ ________________ _______________________ __________

    STATUS SCHOLASTIC STANDING

    Currently Enrolled Good Standing Failing

    Not Enrolled Warning Probation

    GRANTED LEAVE OF ABSENCE EFFECTIVE ______ SEM, SY ___________ until ______ SEM, SY ___________.

    __________________________ __________________________ __________________________


    Program Adviser Department Chair Director of UG/G Program
    Signature over Printed Name Signature over Printed Name Signature over Printed Name
    (if applicable)

    Paid LOA fee:


    O.R. No. ___________________ __________________________ _________________
    Date ___________________ DEAN DATE
    Signature over Printed Name
    STEPS TO FOLLOW BY THE STUDENTS IN FILING LOA:

    1. Secure LOA application form (in triplicate) from your college.


    2. Obtain clearances from the offices mentioned in the LOA form.
    3. If LOA is availed during the second half of the semester, secure the signature of your instructors
    and make sure that they indicate your class standing (Passing or Failing) in the space provided for in
    the LOA form.
    4. Secure the signatures of the Program Adviser, Department Chair, Director of UG/G Program (if
    applicable).
    5. Dean’s signature.
    6. Pay LOA fee of P150.00 at the Cashier’s Office (2nd floor), back of PNB.
    7. Submit LOA form and receipt of payment to the Admission & Registration Section of the OUR.
    8. Submit one copy of the approved LOA to your college.

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