School of Optometry & Vision Sciences - Cardiff University

School of Optometry and Vision Sciences
Personal Absence Form
Session 2010/2011
This form is to be completed and handed in to the School Office for an
approved absence or immediately on return from absence due to illness or
another unavoidable cause.
STUDENT DETAILS
Student name:
____________________________________________________
Student number:
____________________________________________________
Year of study: 1 2 3
(Circle as appropriate)
Reason for submission:
(Circle as appropriate)
a) Self-certification of absence due to illness
b) Certification of absence due to illness requiring a medical note
(Longer than 7 days)
c) Director of Teaching approved absence
d) Director of Teaching approved late submission
MODULE AFFECTED
(To be completed in advance where the request is for an approved absence)
Module Number/Title:
Component/Assessment affected:
Date of absence:
Member of Staff responsible:
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