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Baartiya Saucanaa P'Aovaoigaki Samsqaana, (Laahabaad: Indian Institute of Information Technology, Allahabad

This document is an application form for students at the Indian Institute of Information Technology, Allahabad to request leave from classes. It requests information such as the applicant's name and contact details, home address, dates of proposed leave, and reason for leave. It notes that applications for personal leave must include a request email from parents supporting the reason and length of leave. Applications for medical leave must include a doctor's medical certificate and prescription. Students are reminded that providing false information on the application could result in disciplinary action.

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shivanshu
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45 views1 page

Baartiya Saucanaa P'Aovaoigaki Samsqaana, (Laahabaad: Indian Institute of Information Technology, Allahabad

This document is an application form for students at the Indian Institute of Information Technology, Allahabad to request leave from classes. It requests information such as the applicant's name and contact details, home address, dates of proposed leave, and reason for leave. It notes that applications for personal leave must include a request email from parents supporting the reason and length of leave. Applications for medical leave must include a doctor's medical certificate and prescription. Students are reminded that providing false information on the application could result in disciplinary action.

Uploaded by

shivanshu
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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BaartIya saUcanaa p`aOVaoigakI saMsqaana, [laahabaad

INDIANINSTITUTEOFINFORMATIONTECHNOLOGY,ALLAHABAD

(ACentralUniversity)
(ACentreofExcellenceinITEstablishedbyGovt.ofIndia)
Deoghat,Jhalwa,Allahabad211012(U.P.),India
(APPLICATIONFORLEAVEBYTHESTUDENTSIN(20%)PARTOFATTENDANCEINEACHSUBJECT)

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NameoftheApplicant&His/herMobileNo.

His/herEnrollNo.&HostelAddress..

Name,Address&EmailoftheParent/Guardian.

HomeTownfullAddress

FullContactAddressduringleaveperiodincasethevisitisforaplaceotherthanHomeTown...

Datesofproposedleave

DetailsofHolidays/Semesterbreaksifanysuffixedorprefixedtotheabove

Reasonforleaverequested(SpecifiesoneoutofTotallypersonal/AnyInterview/Medical/AnyProgrammingorother
Competition/PresentingofaConferencePaper/Anyotheretc.)..

WhetherparentsrequestbyEmailisattachedforproposedperiodofleaveincaseofpersonalleaveElse,ifforanyother
leave,propersupportdocumentsfromconcernedauthorityareenclosed(Y/N)?..
..

Declaration:I,(NamewithEnrollNo...)herebydeclarethatall
the information in this application are true. In case any of these is found False/Misleading I shall be liable to due disciplinary
actionsbytheInstitute.

Kindly note that no personal leave application will be entertained without accompanying request of the
Parent/GuardianswhereinHis/herparenthasfullysupportedthereasonforleavealongwiththeperiodofleave.
II. For Medical leave, the application should accompany the copy of the medical prescription slip & original medical
certificatebytheconcernedMBBSDoctorfromwhoseadvicethetreatmenthasbeenadministered.

I.

(Signature)
Date:..
Place:.

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