榮譽學院 格式一

HC Modelo 1

Student’s Leave Application FormStudent’s Leave Application FormStudent’s Leave Application FormStudent’s Leave Application Form

Student Name : Student No :

Faculty/Major : Year of Study: :

Contact No. :

Course CodeCourse CodeCourse CodeCourse Code TitleTitleTitleTitle Teaching FellowsTeaching FellowsTeaching FellowsTeaching Fellows Endorsed byEndorsed byEndorsed byEndorsed by

HONR

I apply / had taken leave from / / (dd/mm/yy) to / / (dd/mm/yy)

and will miss/ have missed a total of _________ class(es) of the above mentioned

course.

Justifications:

…………………………………………………………………………………………….

…………………………………………………………………………………………….

Attachment (Please put a tick � in appropriate item):

□ Copy of medical certificate

□ Other Document: ____________________________________________________

Student’s Signature: Date:

Remarks:

1. This form is only served for courses offered by the Honours College; Students should submit leave

application to relevant faculties for their own programme of studies;

2. Please submit completed form and supporting document(s) to HC General Office.

For Office Use OnlyFor Office Use OnlyFor Office Use OnlyFor Office Use Only

Received date:

Handled by (Staff):

Approved / Disapproved by:

_______________________________

Honours Program Coordinator

Date:

Revision: 002 Updated on 30/10/2009 Form: HC/F001/R2