HP12-ABL

Application/ Report form for Absence from Lesson(s)

Notes to students: 1. Students who wish to apply for leave should submit their applications at least 2 days in advance. 2. Students who are sick and cannot attend scheduled lessons should submit their applications on the day of their next lesson after

their leave. 3. Medical certificate(s) or other supporting document(s) should be provided for consideration by the College. Your supply of personal

information will be treated in strict confidence. 4. According to the “Reference Guide on Issuance of Sick Leave Certificate by Registered Chinese Medicine Practitioners”, the medical

certificates should include the full name as well as the HKID number of the patient. Thus, when you submit a medical certificate issued by a registered Chinese medicine practitioner, please ensure that your HKID number is printed on the certificate.

5. Students should submit the original set of documents stated above to the HPSHCC Office and a copy of the set to each of his/ her lecturers concerned during lesson.

I. Student Particulars

Name: Student No.:

Contact No.: (Home) (Mobile)

Programme: Year:

II. Information of Absent Lesson(s)

Date (dd/mm/yyyy) Course Code Course Title Lecturer(s)

III. Reason(s) for being Absent

Reason(s):

Document(s) attached: medical certificate parent’s explanation letter other supporting documents, please specify:

IV. Declaration

I declare that the information given above is true and correct. I understand that if I knowingly give any false information, I will be subject to disciplinary action.

Signature of Student Date

V. For College Use Form Received on: (Mar 2015)