Form RC/31
(Revised Nov 2016)
RESEARCH OFFICE
研究事務處
Application for Leave of Absence
Please read the Notes to Students overleaf before completing this form.
I.
PARTICULARS OF STUDENT
Name
Mode:
R
Student No.
Full-time
Part-time
Degree:
PhD
(Please as appropriate)
MPhil
Department/School _____________________
Address
Day-time Contact Tel No. _______________________________________
II. APPLICATION DETAILS
Period applied for: from
to
(inclusive)
day/month/year
day/month/year
Reason for application
Signature of Student ________________________________________________
Date _________________________
III. DECISION OF DEPARTMENT/SCHOOL (For Office Use)
[If the student was admitted before the 2016/17 cohort (i.e. before 1 July 2016), Section III should be completed by both the
Chief Supervisor and the Head of Department/ Dean of school. Otherwise, it should be completed by the Chief Supervisor only.]
Application is
 approved  rejected.
(Please as appropriate)
Informed student on
Signature of Chief Supervisor
Date
Signature of Head of Department / Dean of school
Date
------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Name of Student
R
Student No.
Department/School
Degree:
 PhD  MPhil (Please as appropriate)
Application for Leave of Absence
Please be informed that your application for leave of absence from
has not been approved.
Date
to
(inclusive)* has /
Signature of * Chief Supervisor/ Head of Department/ Dean of School ____________________
(*Please delete as appropriate)
Notes to Students
A student who wishes to take leave related to their research activities, e.g., to attend a conference and
present a paper, field study, field trip, data collection, etc. or leave due to sickness or other justifiable
reasons, other than for vacation purposes, should obtain approval from the Chief Supervisor/Head of
Department/Dean of School. The procedures are as follows:
1. Submit an application for leave of absence to the Department/School as early as possible and before the
leave is taken, unless under special circumstances such as accident.
2. Complete Sections I and II of the form. The completed form, together with documentary proof such as a
medical certificate or a letter of certification from the employer, should be returned to the General Office
of the Department/School concerned.
3. A student who is absent from an examination, owing to sickness or other circumstances beyond his/her
control, is advised to consult his/her Department/School for guidance as early as possible.
4. The information given in the form will be used only for the processing of this application.
FormRC31
Nov 2016