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4 views

Loa Form

Uploaded by

elihlefass0
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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LEAVE OF ABSENCE APPLICATION FORM

I hereby offer reason(s) for not fulfilling course requirements i.e. lectures, practicals, tutorials, essays and assignments etc., and make
application for a ‘Leave of Absence’

Name: Student Number:


Date absent from: AM PM To: AM PM
Type of LOA Requested:
Medical Extended Medical Compassionate
Psychological Extended Psychological Sport
Traditional or Religious Extended Traditional or Religious Cultural
Health or Cultural Ceremony Extended Health or Cultural Ceremony Leadership

Reason for Absence: Attach relevant supporting documentation to the LOA form

Details of course work missed: Subject:


Lecture Tutorial Practical Field Trip Essay/assignment Test Other (give details below)
Other details:
Address at Rhodes:

Signature of student:

Application SUPPORTED by:


Name: Phone number:
Designation:
Email: Signature:

For Head of Department


Leave of absence is hereby GRANTED NOT GRANTED

Signature: Date:

To be retained by student
Notes
1. A separate application should be submitted by the student directly to each department.
2. This form, duly completed, and SUPPORTED by the signature of the relevant authority as indicated in the Policy for Leave of Absence (LOA) Applications by Students (see back of
form for details), should be presented to the Head of Department (HoD) whenever prescribed course requirements have been or are going to be missed.
3. If the HoD is satisfied with the explanation given, they will countersign that the LOA has been granted. The tear‐off slip must be retained by the student while the form will be
retained in the department (whether the LOA is granted or not).
Without a counter‐signature from the HoD the form does NOT grant a LOA. The granting of a LOA remains the prerogative of the HoD, and students are advised to familiarise
themselves with Departmental regulations, specifically regarding penalties for not handing in assignments on the due date, not earning marks towards a class record, not writing
tests or the June examinations, and not attending the required minimum number of tutorials, lectures or practicals.
4. Work missed through absence at any time, for any reason, is the responsibility of the individual student. Formal LOA does not remove this responsibility.
5. Supporting documentation e.g. medical certificate should be attached if applicable.

Student name:
Leave of absence is hereby GRANTED NOT GRANTED
Dates: From to
Conditions (if any) are stated on the reverse side of this advice.
Signature of HoD: Date:

It is the responsibility of the student to retain this advice as PROOF of LOA being granted.
SUPPORTING DOCUMENTATION
Please note that documents submitted are tested for authenticity and where fraud is suspected, they are referred to the
University Prosecutor for further action

Type of LOA Requested: Relevant Supporting Authority


Medical ‐ Any qualified health care practitioner, including Health Care Centre
staff
Extended Medical Medical Doctor or Specialist only. Must be confirmed by the relevant
academic Dean
Psychological ‐ Qualified psychologist or psychiatrist
Extended Psychological ‐ Qualified psychologist or psychiatrist. Must be confirmed by the Dean of
Students
Traditional or Religious ‐ Recognised religious leader (minister, priest, imam, rabbi etc.) or House
Warden.
Extended Traditional or Religious ‐ Must be confirmed by the relevant academic Dean
Health or Cultural Ceremony ‐ Recognised religious leader (minister, priest, imam, sangoma, rabbi
etc.) health care practitioner, ward or local government councillor or
justice of the peace or House Warden.
Extended Health or Cultural Ceremony ‐ Must be confirmed by the relevant academic Dean
Compassionate ‐ Death certificate of deceased relative or letter from treating physician
Sport ‐ Team captain or coach AND relevant sports officer
Cultural ‐ Society Chairperson AND Dean of Students
Student Leadership ‐ Chair of relevant University Committee AND Dean of Students

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