Study Break Form
APPLICATION FOR A STUDY BREAK
What is a Study Break?
A study break is a period of time away from your studies for a
maximum period of a year. During this time you will not be
engaged with your programme, receive any academic support
or have access to any University facilities.
If you want to take a
study break starting at
the beginning of an
academic year:
Once approved you leave at the end of one academic year,
have a year away, and then return at the beginning of the
following academic year.
If you want to take a
study break during the
year:
If you wish to take a study break that begins during the
academic year, you may have already completed and
submitted some items of assessment.
You will usually resume your studies at the start of the term in
which you left the previous year (subject to agreement from
any bodies providing funding that this is possible). This will
mean that you have outstanding assessments to complete. It
is possible that you will have assessments due soon after you
return to study. It is your responsibility to prepare for this and
a break in study cannot be used in mitigation.
To help you be prepared for resuming your studies we will
contact you in good time and ask you to complete preenrolment. This will give you access to NILE so that you can
check when your assessments are due and prepare for these.
Who must you ask for
advice before your
request can be
approved?
Programme Leader: to discuss the course (ie will all your
modules be running, will there be changes in the award map?
Academic Advice Manager: to make sure the decision is the
best one for you (ie can you progress, are there additional
regulations etc).
PBS Compliance Manager: if you are an International
Student you must make sure that your visa allows you to take
a study break.
What to do: complete sections 1 and 2 of this form; take the form to your Programme
Leader, they will advise you and sign the form. Then take the form to the Student Desk in
the Student Centre or email it to [email protected]
IMPORTANT: if you are an International Student you MUST take this form to the PBS
Compliance Manager.
The University of Northampton will:
 write to you to confirm approval of the study break, noting the anticipated return date,
and any specific requirements regarding resits etc.
 complete the necessary procedures and inform Student Loans/ Bursaries/other
external bodies/all relevant university departments.
 contact you prior to the anticipated date of return to study to confirm your return.
 invite you, on confirmation of your intended return, to a review meeting with the
Programme Leader and/or Academic Advice Manager. This meeting will confirm your
readiness to return, confirm the return date and any other requirements prior to recommencement of the course (eg Occupational Health clearance).
Study Break – Green
September 2015
1
Study Break Form

Section 1: You (the student) must complete this section in full
Name: ............................................................ Student No: ......................................
Contact Telephone No: .................................
Last Date of Attendance : .................
COURSE: ………………………………………………………………………………...…………………………………………
Modules being studied (please use module codes as found on the award map):
I wish to take a study break from the University of Northampton –
from: ………./…………./……….. to ………./…………./……….. (please give exact dates DD/MM/YY)
Reason for request: …………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………..

Section 2: You (the student) must complete this section in full
I have read and understand the guidance given on this form, and I have consulted the
Programme Leader and Academic Advice Manager, and (for International Students) the PBS
Compliance Manager. I accept responsibility for any consequences of not acting on the advice
I have been given.
I understand that the study break will be confirmed in writing by The University of
Northampton and that this confirmation will include details of any specific requirements
regarding assessments etc. I am also aware that there may be assignments due immediately
when I return and that a recent study break will not be accepted as mitigation.
Signed: ………………………………………………………………………………………… Date: ………………………………

PLEASE SEE OVER PAGE – YOU MUST GET THIS SECTION
COMPLETED AND SIGNED
Study Break – Green
September 2015
2
Study Break Form

Section 3: You must seek advice and obtain signatures for this
section. Your study break will NOT be approved if this section is
incomplete:
PROGRAMME LEADER
The student has discussed this study break with me and
has been given the following advice:
PRINT NAME:
…………………………………………………..
Signed: ……………………………………
Date: …………………………………………
ACADEMIC ADVICE MANAGER
The student has discussed this study break with me and
has been given the following advice:
PRINT NAME:
…………………………………………………..
Signed: ……………………………………
Date: …………………………………………
INTERNATIONAL STUDENTS:
PBS Compliance Manager
The student has discussed this study break with me and
has been given the following advice:
PRINT NAME:
…………………………………………………..
Signed: ……………………………………
Date: …………………………………………
SENIOR TEAM LEADER – FINAL APPROVAL
Comments:
Confirmed dates of study break period: ………./…………./……….. to ………./…………./………..
Signature:
Name:
OFFICE USE:
Approval letter sent to student
Module Leaders
International Students:
Study Break – Green
September 2015
Date:
QLS amended
Internal notification:
Other Student Records
/Exams/Placements
Student Loan Co/bursaries
Form signed by PBS Compliance Manager?
Copy form sent to ISSS
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