OTR - Form - Leave of Absence/Withdraw

Request for
[field_1681403312967_85]
from Program

Policy Reference: AC 3.19.1

Student Information

First Name

Last Name

SAIT ID

Are you a current student?

Yes

This form is for current students only. Please contact inquiry@sait.ca.

Student Type

	Domestic (Canadian Citizen, Permanent Resident or Accepted Refugee)
	International Student (study permit holders or temporary visitors)

Are you planning on coming back to the program at a future date?

Yes

Planned return date

Program of Study

Major

SchoolCode

Request Reason

	Parental
	Religious
	Personal Circumstances
	Extenuating Circumstances

Type of parental request

	Maternity
	Paternity
	Adoption

Student Medical

A required for the student to address or treat the student’s physical illness or injury (either chronic or temporary), mental health illness or conditions, or hospitalization.

Family Medical

A required for the student to address or treat a family member’s physical illness or injury (either chronic or temporary), mental health illness or conditions, or hospitalization. A family member is defined as a person usually related by blood, marriage or adoption, or living in the same household, or a legal or de facto guardian.

Humanitarian

A required for the student to complete a full-time humanitarian mission related to a student’s work with the provincial or federal government or with a non-governmental organization (NGO). The leave is usually outside of Calgary, and may be domestic or international.

Legal

A required for a student to meet legal obligations such as extended jury duty.

Military

required for a domestic student to meet the student’s military service obligations as a member of the Canadian Armed Forces or for an international student to meet the student’s military service obligations to the student’s home country.

Parental

Maternity, paternity and adoption .

Religious

A required for the student to complete a full-time religious mission related to a student’s membership in a religious-affiliated cause. The leave is usually outside of Calgary, and may be domestic or international.

Personal Circumstances

For when you need leave the program for reasons other than medical, family medical, humanitarian, legal, military, religious or parental.

Extenuating Circumstances

For extenuating circumstances that includes, for instance, bereavement, caregiving and work obligations.

Please provide detail on why you are requesting this request

Please Note! In your confirmation email, you will recieve a medical form for your doctor to complete to provide us with the necessary information and a link to upload the filled out form to.

International Student

After submitting this form, please contact International Centre to understand the potential impact of this request on your immigration status. Once you have been informed (either via email or in an appointment) this request will be processed.

If you have any documentation (e.g. your current study permit) for the International Centre to review along with this request, please upload it into the box below.

PDF or Microsoft Word files only accepted

FOIP Statement

The personal information provided on this form is collected under the authority of the Freedom of Information and Protection of Privacy Act of the Province of Alberta, Section 33(c). The purpose of this personal information is to respond to your request leave or withdraw for medical purposes. Your personal information is protected by Alberta’s Freedom of Information and Protection of Privacy Act and can be reviewed on request. If you have any questions about the collection or use of this information, contact the FOIP Coordinator at 403.284.8748

Submit

Request for
Leave of Absence

The request for [field231] [field727] has already been actioned.

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