The University of Hong Kong s1

SS120/1212 THE UNIVERSITY OF HONG KONG FACULTY OF SOCIAL SCIENCES

Application for Leave of Absence (Taught Postgraduate Student)

A. To be completed by student

1. Name: ______University no.: ______(Surname) (First Name)

Department: ______Curriculum & Year: ______Study mode: FT/PT*

2. Purpose and Details of Leave (please tick as appropriate)  Personal Reasons  Work-related Reasons  Medical Reasons Detailed justifications for the application: (Please attach supporting documents, and use additional sheet(s) if the space provided below is insufficient) ______3. Period of Leave Requested:  First semester of academic year 20______- ______ Second semester of academic year 20______- ______ Specific period: from ______to ______

4. Course(s) to be Dropped if Leave is granted: Semester Semester Course Code (Subject Area + Catalogue (academic year) Course Code (Subject Area + Catalogue (academic year) Number) e.g. CHEM1001, CHEM1001FY e.g. First semester Number) e.g. CHEM1001, CHEM1001FY e.g. First semester (2012-13) (2012-13)

Signature: ______Date: ______Student

B. To be completed by Head of Department / Programme Director I support / do not support* the application

Remarks (if any): ______

Signature: ______Date: ______Head of Department / Programme Director

C. To be completed by the Dean I approve / do not approve* the application of leave of absence

Remarks (if any): ______

Signature: ______Date: ______Dean

D. To be completed by the HSSDC and FB I support / do not approve* dropping of courses I support / do not support* dropping of courses

Signature: ______Signature: ______HSSDC Chairman FB Chairman Date: Date:

* Delete as appropriate