Leave of Absence Request Form
Department		Major			Semester
Name		Birth Date			Student ID
Address
Mobile.	1st			E-mail
	2nd
Leave of Absence				Expected semester of returning to school		ex) 2021-1st semester
Reason for requesting
Tuition payment status	Payed / Unpayed			Date of Payment
Refund Bank Account #				Bank

Authorization	Thesis Advisor	Department Dean		International Education Center		Graduate School Office	Staff	Graduate School Office Team Leaer

Hereby I request for leave of absence

(Signature)

Request Date :

Student :

.        .         .

*Among the students who take a leave of absence, please make sure to fill out the refund details and attach a copy of your bank account if you have payed the tuition.