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    Form No:OAA.01.

    02

    INTERNATIONAL UNIVERSITY SOCIALIST REPUBLIC OF VIETNAM


    OFFICE OF UNDERGRADUATE Independence – Freedom – Happiness
    ACADEMIC AFFAIRS

    REQUEST FORM FOR TEMPORARY LEAVE


    To: The Management Board of IU & Office of Academic Affairs

    STUDENT INFORMATION:
    Student full name: ……………………………………………… Student ID: .....................................
    Date of birth: …………………… Phone number: …………………........... Email: ...........................
    School/Department of: ……………………………………………………… Intake: ………… -
    …………
    REQUEST INFORMATION:
    Semester of leave: ……………………, academic year: ………… - …………
    Semester of return: ……………………, academic year: ………… - …………
    My disability of understanding the lecture in English
    Weak health
    My financial difficulties
    ……………………………………………………………………………

    1.Date: …… / …… / ………… 4.SCHOOL/DEPARTMENT’S 6. FOR IU LIBRARY (1st floor)


    Student’s signature: Date: …… / …… / …………
    APPROVAL
    ………………………………… Signature:

    …………………………………

    ………………………………….

    Date: …… / …… / …………
    2.PARENTS’ AGREEMENT Signature:
    ……………………………………………...
    7. OFFICE OF STUDENT
    ……………………………………………... SERVICES
    …………………………………..............
    Date: …… / …… / ………… ....
    Phone
    number: ……………………… …………………………………..............
    Signature: .....
    5. OFFICE OF INTERNATIONAL Date: …… / …… / …………
    ACADEMIC
    Signature:
    COLLABORATION

    3. ADVISOR’S APPROVAL (For student of twinning program


    ONLY)
    After consulting with the student's parents, I
    ………………………………………….
    ensure that the student's request for
    …..………………………………………
    temporary leave has been approved by the
    parents. ………………………………………….. 8. OFFICE OF ACADEMIC
    Date: …… / …… / ………… Date: …… / …… / ………… AFFAIRS Date of receipt: ……
    Signature: Signature:
    / …… / ………… Date of Signature:

    response: …… / …… / …………

    * Students require strictly following above steps to complete this


    form.

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