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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  • LEAVEOFABSENCEAPPLICATIONFORM

    Iherebyofferreason(s)fornotfulfillingcourserequirementsi.e.lectures,practicals,tutorials,essaysandassignmentsetc.,andmakeapplicationforaLeaveofAbsence

    Name: StudentNumber:

    Dateabsentfrom: AM PM To: AM PM

    TypeofLOARequested: Medical ExtendedMedical Compassionate Psychological ExtendedPsychological Sport TraditionalorReligious ExtendedTraditionalorReligious Cultural HealthorCulturalCeremony ExtendedHealthorCulturalCeremony Leadership

    ReasonforAbsence:AttachrelevantsupportingdocumentationtotheLOAform

    Detailsofcourseworkmissed: Subject:

    Lecture Tutorial Practical FieldTrip Essay/assignment Test Other(givedetailsbelow)

    Otherdetails: AddressatRhodes:

    Signatureofstudent:

    ApplicationSUPPORTEDby:

    Name: Phonenumber:

    Designation:

    Email: Signature:

    ForHeadofDepartment

    Leaveofabsenceishereby GRANTED NOTGRANTED Signature: Date:

    ToberetainedbystudentNotes1. Aseparateapplicationshouldbesubmittedbythestudentdirectlytoeachdepartment.2. Thisform,dulycompleted,andSUPPORTEDbythesignatureoftherelevantauthorityasindicatedinthePolicyforLeaveofAbsence(LOA)ApplicationsbyStudents(seebackof

    formfordetails),shouldbepresentedtotheHeadofDepartment(HoD)wheneverprescribedcourserequirementshavebeenoraregoingtobemissed.3. IftheHoDissatisfiedwiththeexplanationgiven,theywillcountersignthattheLOAhasbeengranted.Thetearoffslipmustberetainedbythestudentwhiletheformwillbe

    retainedinthedepartment(whethertheLOAisgrantedornot).WithoutacountersignaturefromtheHoDtheformdoesNOTgrantaLOA.ThegrantingofaLOAremainstheprerogativeoftheHoD,andstudentsareadvisedtofamiliarisethemselveswithDepartmentalregulations,specificallyregardingpenaltiesfornothandinginassignmentsontheduedate,notearningmarkstowardsaclassrecord,notwritingtestsortheJuneexaminations,andnotattendingtherequiredminimumnumberoftutorials,lecturesorpracticals.

    4. Workmissedthroughabsenceatanytime,foranyreason,istheresponsibilityoftheindividualstudent.FormalLOAdoesnotremovethisresponsibility.5. Supportingdocumentatione.g.medicalcertificateshouldbeattachedifapplicable.

    Studentname:

    Leaveofabsenceishereby GRANTED NOTGRANTED Dates:From to Conditions(ifany)arestatedonthereversesideofthisadvice.

    SignatureofHoD: Date:

    ItistheresponsibilityofthestudenttoretainthisadviceasPROOFofLOAbeinggranted.

  • SUPPORTINGDOCUMENTATIONPleasenotethatdocumentssubmittedaretestedforauthenticityandwherefraudissuspected,theyarereferredtotheUniversityProsecutorforfurtheraction

    TypeofLOARequested: RelevantSupportingAuthorityMedical Anyqualifiedhealthcarepractitioner,includingHealthCareCentre

    staffExtendedMedical MedicalDoctororSpecialistonly.Mustbeconfirmedbytherelevant

    academicDeanPsychological QualifiedpsychologistorpsychiatristExtendedPsychological Qualifiedpsychologistorpsychiatrist.MustbeconfirmedbytheDeanof

    StudentsTraditionalorReligious Recognisedreligiousleader(minister,priest,imam,rabbietc.)orHouse

    Warden.ExtendedTraditionalorReligious MustbeconfirmedbytherelevantacademicDeanHealthorCulturalCeremony Recognisedreligiousleader(minister,priest,imam,sangoma,rabbi

    etc.)healthcarepractitioner,wardorlocalgovernmentcouncillororjusticeofthepeaceorHouseWarden.

    ExtendedHealthorCulturalCeremony MustbeconfirmedbytherelevantacademicDeanCompassionate DeathcertificateofdeceasedrelativeorletterfromtreatingphysicianSport TeamcaptainorcoachANDrelevantsportsofficerCultural SocietyChairpersonANDDeanofStudentsStudentLeadership ChairofrelevantUniversityCommitteeANDDeanofStudents

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