Leave of Absence Application Form - Rhodes ?· LEAVE OF ABSENCE APPLICATION FORM ... for not fulfilling…

Download Leave of Absence Application Form - Rhodes ?· LEAVE OF ABSENCE APPLICATION FORM ... for not fulfilling…

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<ul><li><p>LEAVEOFABSENCEAPPLICATIONFORM</p><p>Iherebyofferreason(s)fornotfulfillingcourserequirementsi.e.lectures,practicals,tutorials,essaysandassignmentsetc.,andmakeapplicationforaLeaveofAbsence</p><p>Name: StudentNumber: </p><p>Dateabsentfrom: AM PM To: AM PM </p><p>TypeofLOARequested: Medical ExtendedMedical Compassionate Psychological ExtendedPsychological Sport TraditionalorReligious ExtendedTraditionalorReligious Cultural HealthorCulturalCeremony ExtendedHealthorCulturalCeremony Leadership </p><p>ReasonforAbsence:AttachrelevantsupportingdocumentationtotheLOAform </p><p>Detailsofcourseworkmissed: Subject: </p><p>Lecture Tutorial Practical FieldTrip Essay/assignment Test Other(givedetailsbelow)</p><p>Otherdetails: AddressatRhodes: </p><p>Signatureofstudent: </p><p>ApplicationSUPPORTEDby: </p><p>Name: Phonenumber: </p><p>Designation: </p><p>Email: Signature: </p><p>ForHeadofDepartment </p><p>Leaveofabsenceishereby GRANTED NOTGRANTED Signature: Date: </p><p>ToberetainedbystudentNotes1. Aseparateapplicationshouldbesubmittedbythestudentdirectlytoeachdepartment.2. Thisform,dulycompleted,andSUPPORTEDbythesignatureoftherelevantauthorityasindicatedinthePolicyforLeaveofAbsence(LOA)ApplicationsbyStudents(seebackof</p><p>formfordetails),shouldbepresentedtotheHeadofDepartment(HoD)wheneverprescribedcourserequirementshavebeenoraregoingtobemissed.3. IftheHoDissatisfiedwiththeexplanationgiven,theywillcountersignthattheLOAhasbeengranted.Thetearoffslipmustberetainedbythestudentwhiletheformwillbe</p><p>retainedinthedepartment(whethertheLOAisgrantedornot).WithoutacountersignaturefromtheHoDtheformdoesNOTgrantaLOA.ThegrantingofaLOAremainstheprerogativeoftheHoD,andstudentsareadvisedtofamiliarisethemselveswithDepartmentalregulations,specificallyregardingpenaltiesfornothandinginassignmentsontheduedate,notearningmarkstowardsaclassrecord,notwritingtestsortheJuneexaminations,andnotattendingtherequiredminimumnumberoftutorials,lecturesorpracticals.</p><p>4. Workmissedthroughabsenceatanytime,foranyreason,istheresponsibilityoftheindividualstudent.FormalLOAdoesnotremovethisresponsibility.5. Supportingdocumentatione.g.medicalcertificateshouldbeattachedifapplicable.</p><p>Studentname: </p><p>Leaveofabsenceishereby GRANTED NOTGRANTED Dates:From to Conditions(ifany)arestatedonthereversesideofthisadvice.</p><p>SignatureofHoD: Date: </p><p>ItistheresponsibilityofthestudenttoretainthisadviceasPROOFofLOAbeinggranted.</p></li><li><p>SUPPORTINGDOCUMENTATIONPleasenotethatdocumentssubmittedaretestedforauthenticityandwherefraudissuspected,theyarereferredtotheUniversityProsecutorforfurtheraction</p><p>TypeofLOARequested: RelevantSupportingAuthorityMedical Anyqualifiedhealthcarepractitioner,includingHealthCareCentre</p><p>staffExtendedMedical MedicalDoctororSpecialistonly.Mustbeconfirmedbytherelevant</p><p>academicDeanPsychological QualifiedpsychologistorpsychiatristExtendedPsychological Qualifiedpsychologistorpsychiatrist.MustbeconfirmedbytheDeanof</p><p>StudentsTraditionalorReligious Recognisedreligiousleader(minister,priest,imam,rabbietc.)orHouse</p><p>Warden.ExtendedTraditionalorReligious MustbeconfirmedbytherelevantacademicDeanHealthorCulturalCeremony Recognisedreligiousleader(minister,priest,imam,sangoma,rabbi</p><p>etc.)healthcarepractitioner,wardorlocalgovernmentcouncillororjusticeofthepeaceorHouseWarden.</p><p>ExtendedHealthorCulturalCeremony MustbeconfirmedbytherelevantacademicDeanCompassionate DeathcertificateofdeceasedrelativeorletterfromtreatingphysicianSport TeamcaptainorcoachANDrelevantsportsofficerCultural SocietyChairpersonANDDeanofStudentsStudentLeadership ChairofrelevantUniversityCommitteeANDDeanofStudents</p></li></ul>

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