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CPS-REG/8/2005 (1)

CONFIDENTIAL

CENTRE FOR POSTGRADUATE STUDIES


APPLICATION FOR LEAVE OF ABSENCE
(FOR POSTGRADUATE STUDENTS WITH G.. MATRIC NO.)

*** 2 SEMESTERS - SEM 1 2013/2014

AND

SEM 2 2013/2014

SEMESTER .. SESSION .
INSTRUCTIONS
To Candidate
1. Please complete Section A. You are required to submit this form to the Deputy Dean (Postgraduate)
of your Kulliyyah/Institute.
2. Sponsored students who would like to apply for leave of absence for any reason, must enclose
consent / approval letter for the leave of absence from their sponsor(s).
3. A student will not be granted a leave of absence unless the following conditions are fulfilled:
3.1 To attend class as usual and sit for any mid-term/final examinations
3.2 To submit the application form together with a valid air ticket/any travelling documents to the
Centre before leaving the country. The following table exemplifies some of the reasons and the
relevant necessary documents.
Reasons

Supporting Documents

1. Medical problem
e.g.: accidents, and any other serious
health problems

Medical report certified by the IIUM Health


Centre and, air ticket for International Students

2. Personal problems
e.g.: family problems, marriage problems,
stress

Counselor report certified by the IIUM


Counseling & Career Guidance Department or
IIUM Health Centre and, air ticket for
International Students

3. Work constraints

Recommendation letter from employer, air ticket


and work permit for International Students

NOTE:

Please complete the CPS-ADM/1/2005 form if you have any changes in your personal
particulars (such as e-mail address & mobile phone number).

To Deputy Dean (Postgraduate) of the Kulliyyah/Centre/Institute


1. Please submit the completed form to the Dean, Centre for Postgraduate Studies.
2. Please also ensure the relevant supporting documents are attached.
Important Notes
The implementation of the Leave of Absence has been effective since Semester I, 2001/2002. The
counted/uncounted status does not apply to all postgraduate students registered prior to Semester
I, 2001/2002.

SECTION A : TO BE COMPLETED BY THE CANDIDATE


1. Name: TANVIR AHMED

2. Matric Card No.: G1225619

3. Programme:

4. Telephone No.: 01128050090

MIT

5. Reason(s) for Leave of Absence requested. Please attach any supporting document(s).
My father, aged 62, has been detected to have LUNG CANCER since last month. Being the only son of my parents,
I badly require
to accompany him during some travels in overseas hospital. Because my mother alone facing problems to
..
manage this situation. Im facing huge difficulties to continue and concentrate on my postgraduate studies at the
moment. I .....
request to issue me a two SEMESTER (SEP 1 13/14, SEP 2 13/14) leave on this urgent family issue.
*** Please find attached DOCTORs prescription from Bumrungrad International Hospital
and my TRAVEL TICKET.

**FOR STUDENT ON IIUM FINANCIAL LOAN


I understand that if my application is successful, my financial loan will be suspended during the approved
leave of absence period.
Students Signature :

Date :

SECTION B : TO BE COMPLETED BY THE HEAD OF DEPARTMENT (IF RELEVANT)


Recommended

Not Recommended

Remarks: ...
..

______________________
Signature & Stamp

______________
Date

SECTION C : TO BE COMPLETED BY THE DEPUTY DEAN (POSTGRADUATE) OF THE KULLIYYAH/


INSTITUTE
Approved

Not Approved

Remarks: ..

______________________
Signature & Stamp

______________
Date

OFFICE USE (CENTRE FOR POSTGRADUATE STUDIES)


Date Received

Action / Remarks

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