Leave of Absence


Leave of Absence Form

Student Name:  

Location: Fort Myers

Instructor:  

Program:

Class Day of Week: Time of Class:  

Date of Class Start: Last Date of Attendance:

By digital signing this document you are agreeing to and understand the IMDT Leave of Absence rules and regulations that have been laid out in the IMDT Catalog. After submission this document will be sent to the proper channels for approval. Your IMDT representative will reach out once approved. Please email us at [email protected] if more guidance is needed. 

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: Leave of Absence
lock iconUnique Document ID: 8d05d641ed90828c33f4d71eedf7b6847bf1b265
Timestamp Audit
September 4, 2020 8:15 am CDTLeave of Absence Uploaded by Cassie Black - [email protected] IP 99.190.9.234
September 8, 2020 7:13 am CDTIMDT Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234
April 15, 2022 9:55 am CDTIMDT Documents - [email protected] added by Cassie Black - [email protected] as a CC'd Recipient Ip: 99.190.9.234