Form – Apply for leave of absence from studies

Name Both first name and surname

Personal number Enter your personal identity number or interim identity number, 12 digits (YYYYMMDDNNNN)

E-mail

Telephone number

Which semester will your leave of absence commence Specify as S24, A24, S25, etc.

Number of semesters *

1 semester
2 semesters

Programme

Yes, I consent to the storing and administration of submitted data. Information submitted here will be processed by Chalmers to administer this issue. Read more about processing of personal data at www.chalmers.se/personaldata.