Withdrawal/Leave of Absence Form

Policy A/AB/018

Complete and submit this form to Registry: Student Information Centre, Building 8.

Use this form to Withdraw or take a Leave of Absence (LA) from your programme of study. Students are required to
maintain their enrolment each semester.
Withdraw: Leave the Polytechnic forever.
Leave of Absence (LA): Take a break from study for a maximum of two semesters in a programme. It is your
responsibility to inform Bahrain Polytechnic of your return and to register for classes.
It is advised that you see you Programme Manager to discuss your options before completing this form.
You must fully complete this form and gain clearance from relevant departments before it can be processed (over).

Part 1: Student to complete

ID Semester __ , Academic Year 20__ /20__
Name
Programme Mobile
I wish to LEAVE of ABSENCE for: 1 Semester 2 Semesters
I wish to WITHDRAW (leave the Polytechnic forever)
Reasons for Withdrawal or leave of Absence: (Must Choose One)
Medical Reasons Family Reasons
Change in employment states Financial Reasons
Transfer to another institute (Please Specify):_________________________________________________
Other (Please Explain): ___________________________________________________________________
________________________________________________________________________________________
03-03-2016 Last day to Withdraw or take Leave of Absence, with refund (less administration fee).
31-03-2016* Last day to Withdraw or take Leave of Absence, no refund, No Academic Penalty W grade.
After 31-03-2016 Withdrawing or taking Leave of Absence results in an Academic Penalty, WF grade.

Declaration: The information on this form is correct.

Leave of Absence Students:
I understand that on my return to study I will be subject to the Programme requirements and course
enrolment opportunities available at the time.
Withdrawing Students:
I understand that if I Withdraw and decide to resume my studies at Bahrain Polytechnic, I must reapply for
admission through the Polytechnics Admissions Office and any re-enrollment is subject to meeting
admission requirements and space availability at that time.

Signature: Date:

* Note: If this form is completed by a parent or guardian to whom the student has approved signing rights
(refer to the Teaching and Learning Agreement), please include a copy of the CPR with this form verified by a
Senior Enrolment officer, Enrolment Manager or the Registrar.

Details:

Procedure (F/AB/018/_) v.201401a Page 1 of 2

Part 2: Approval/ Clearance (Required from each of the following Departments in this order)

Academic Advisor/ Approved Name:

Programme Manager Comments: Signature:
(Recommended)
Date: / /

Approved Name:
Library
(Building 19) Comments: Signature:
Date: / /

Approved Name:
Security
(Building C8) Returned: ID Card Locker Key Car Sticker Signature:
Comments: Date: / /

Approved Name:
Scholarship/ Grant
(8.07, If relevant) Comments: Signature:
Date: / /

Approved Name:
Finance
(Building 11) Comments: Signature:
Date: / /

Part 3: Registry Use Only

This form was initiated by student: Yes No If no, why this form was initiated:
___________________________________________________________________________________________
___________________________________________________________________________________________
INSTITUTIONAL WITHDRAWAL: Initiated by the Polytechnic

Student did not register for classes or maintain enrolment (after 2nd week of Semester)
IS
Academic Standing Excluded (after Appeal period expires- no appeal or declined)
Enrolment Manager OR
Registrar Signature: Date: / /
Student Enrolment Course Administrative Counts in GPA Last Day Tick
Status Status status grade appropriate
WS WR WR No GPA 20-09-2016
No grade
IS WR WR (no course registration) 20-09-2016
WS/LA WD WD W Not calculated in GPA 23-10-2016
WS/LA WF WF WF Assigned 0 towards To end of
WS/LA WD/WF WA WA (remains) GPA Semester
Processed in Banner by: Date: / /

Procedure (F/AB/018/_) v.201401a Page 2 of 2