Leave Application Form (IC-T08) - Industrial Centre

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Leave Application Form (IC-T08) - Industrial Centre

IC-T08(Apr 2013)Leave Application & Make-Up ArrangementPlease read the notes overleaf before completing this form. Please tick as appropriate.For Student Academic Year 20 __ __ / __ __ Intake Year 20 __ __I. Particulars of StudentInstitutions PolyU HKUST CUHK CityU Others:Faculty/DepartmentStudent NameStudent No.Programme CodeYear of StudyContact No.II. Leave Details (Use one application form for each workshop)Subject Code Component Code IC GroupModule Code TM WorkshopDate(s) of LeaveTotal Leave DurationsReasons( day(s) / session(s) / hour(s)) Academic Week Sickness (medical certificate issued by registered practitioner is required) with attachments Others, please state the supporting reasons for this application(supporting document and/or explanatory letter is/are required) with attachmentsI, the undersigned, hereby declare that: (1) I understand that absence from IC training must be made up before the finalization of result inthat semester; (2) I understand that IC will only arrange the make-up classes accordingly to the available schedules; (3) I have to bear allrisks of my academic award being withheld due to incompletion of IC Training; (4) The information given in this application is correct to thebest of my knowledge and belief; and (5) I consent to the making of any enquiries necessary for verifying and processing this application.SignatureFor Student Affairs Officer (SAO)Leave EndorsementJustification Declined with penalty__________ day(s)/ hour(s)* Approvedwith supporting documentchecked Yes NoDateFor General Office (GO)Entered Yes NoMake-Up Arranged Yes NoRemarksSignature of SAODate* Delete as appropriate(Ir Dr Martin Wong / Mr Simon Hui)*StaffDate


IMPORTANT NOTES TO STUDENTSSick Leave1. Retrospective approval of sick leave can be applied from IC Student Enquiry Counter after the sick leave hasbeen taken. Such applications must be accompanied by a certificate from a registered medical practitioner.Other leave1. IC DO NOT normally approve other leaves from your scheduled IC training.2. If you must take other leave, you must apply for leave at least 4 working days prior to the leave date bycompleting this form. You should fill in the form and approach the IC Student Affairs Officer (SAO) for approval.3. The IC SAO are:Ir Dr Martin WongTel: 2766 7625Email: martin.cm.wong@polyu.edu.hkLocation: Room W106/W002Mr Simon HuiTel: 2766 4810Email: simon.hui@polyu.edu.hkLocation: W1054. Leave applications MUST be accompanied by supporting documents. If you are not sure of what kinds ofdocuments are sufficient for your case, you may seek the counsel of SAO, who will advise you what supportingdocuments or explanatory letters are needed. Please note that SAO’s decisions in such matters are final.5. Approved form should be submitted to the IC Student Enquiry Counter in person.6. In the case that SAO declined your leave application but you determined to take the leave anyway, you shouldsubmitted the declined form to IC Student Enquiry Counter in person for make-up arrangement.7. Please note that absence from IC training for half-a-day or more, even with approval, must be made up. You arestrongly advised to make up any such missed training before the finalization of result in that semester. Once thesubject result has been finalized and released, your make up will not be counted. The IC Student EnquiryCounter will help you with the logistics.8. If for any reason you are absent from training without approval a penalty will be imposed upon you, usually inthe form of extra training or work experience, the extent of the penalty being determined by the gravity of thecase. Ordinarily you will require to make up a period of training double that of the unauthorized leave.Make-up Training1. You should refer to the IC training timetables which are posted on the notice board located in the podium of ICBuilding or the IC Web Site at http://www.ic.polyu.edu.hk for possible session(s) to make up the missed training.2. Make-up Training can be arranged at the IC Student Enquiry Counter in person.3. The IC Student Enquiry Counter will issue a Make-up Training Attendance Form for confirmation. Onlineapplication will be confirmed by email.4. You should attend the make-up training as scheduled and present the Form to the IC staff of the Workshopwhom will sign the form to certify the attendance of student.5. The signed Make-up Training Attendance Form should be submitted to the IC Student Enquiry Counter after themake-up training.6. If you cannot attend the arranged make up training as expected, you should inform the IC General Office as soonas practicable before the scheduled training date and make the alternative arrangements. Otherwise yourabsence from make-up training will be treated as absence without approval.Remarks:The information you provided in this form, including any subsequent changes, will be used for the abovementionedapplication of the Industrial Centre only.

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