<p> SS120/1212 THE UNIVERSITY OF HONG KONG FACULTY OF SOCIAL SCIENCES</p><p>Application for Leave of Absence (Taught Postgraduate Student)</p><p>A. To be completed by student</p><p>1. Name: ______University no.: ______(Surname) (First Name)</p><p>Department: ______Curriculum & Year: ______Study mode: FT/PT*</p><p>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 ______</p><p>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)</p><p>Signature: ______Date: ______Student</p><p>B. To be completed by Head of Department / Programme Director I support / do not support* the application</p><p>Remarks (if any): ______</p><p>Signature: ______Date: ______Head of Department / Programme Director</p><p>C. To be completed by the Dean I approve / do not approve* the application of leave of absence</p><p>Remarks (if any): ______</p><p>Signature: ______Date: ______Dean</p><p>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</p><p>Signature: ______Signature: ______HSSDC Chairman FB Chairman Date: Date:</p><p>* Delete as appropriate</p>