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Personal MedicalLeaveApplicationForm

This document is an application for leave from the Indian Institute of Management, Ahmedabad two-year postgraduate program. It collects information such as the student's name, year, dorm number, mobile number, dates of requested leave, reason for leave including any required medical endorsement, course details with classes missed, and travel schedule. A medical leave proforma is also included to be signed by the institute doctor if leave is for medical reasons.

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abhishek200918177825
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45 views1 page

Personal MedicalLeaveApplicationForm

This document is an application for leave from the Indian Institute of Management, Ahmedabad two-year postgraduate program. It collects information such as the student's name, year, dorm number, mobile number, dates of requested leave, reason for leave including any required medical endorsement, course details with classes missed, and travel schedule. A medical leave proforma is also included to be signed by the institute doctor if leave is for medical reasons.

Uploaded by

abhishek200918177825
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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INDIAN INSTITUTE OF MANAGEMENT, AHMEDABAD

TWO YEAR POST GRADUATE PROGRAMME IN MANAGEMENT



APPLICATION FOR LEAVE

1. Name : Roll No:

2. Year : I/II Section :

3. Dorm No.. : Mobile No. :

4. a. Leave requested from ________________ to _________________

a. No. of days

5. Reason for Leave :
(If medical, kindly get Endorsement
from the Institute Doctor in the
prescribed form

6. Course details :

List all the courses of
classes missed
Total no. of
sessions in the
course
Date(s) of
classes missed
Class(es)
missed earlier
No. of classes
missed / to be
missed this
time
Total no. of
classes missed












7. Travel Schedule :




Date : Student Chaiperson-PGP / PGP Office
(Signature) (Signature)

_________________________________________________________________________________________

PROFORMA FOR MEDICAL LEAVE

I have examined Mr. / Ms. ______________________________________________________
a PGP I / II student and found that he / she is suffering from ____________________________.
He / She has been advised complete rest ______ day/s with effect from __________________.




Signature of the Institute Doctor

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