SVKM’s NMIMS Kirit P.
Mehta School of Law
Application Form for Leave of Absence from Student
Date:
Name of Student: Roll Number:
SAP Id:
Contact Phone number: Email ID:
Programme: Branch:
Semester: Division:
Parent’s Contact number: Email ID:
Reason of Absence: Medical / Placement Activity / Event Participation through College
/ Death in family / Other (Tick ‘ √ ' on appropriate reason of absenteeism )
Dates:
From _________________ to ______________________ No. of Days _________
(dd/mm/yy) (dd/mm/yy)
( Provide evidence wherever necessary ) – Documents Attached YES / NO
NOTE: Medical Certificate must be duly signed and stamped from Registered Physician
Details of Lectures/ Practical’s missed [Refer Annexure I]
Name of Subject Lecture Date & Time Practical Date & Time Faculty Name
1.
2.
3.
4.
5.
I hereby declare that the reasons stated above are genuine to the best of my knowledge. I undertake to maintain at
least 80% attendance in each subject for the Semester. I understand that all Leave must remain within a maximum of
20% for each subject. I understand that I do not meet the course requirements in the event that my absence exceeds
20% and suitable action in accordance with the prevailing attendance rules may be taken by the management in this
regard. I will be responsible for all term work / evaluations etc, which I missed during this absenteeism.
________________________________________ ________________________________
Name & Signature of parents: Signature of Student:
Date: Date:
Approved by:
Signature of Chairperson Signature of the Recipient and Date:
_________________
Date:
Note: This form along with supporting documents must be submitted within 3 days after resuming the
college .
ANNEXURE -I
Details of Lectures/ Tutorial’s missed [Attach extra sheet if required]
Name of Subject Lecture Date & Time Tutorial Date & Time Faculty Name
1
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
