Student Leave of absence Application Form
Student's Name:
*
Madrasa Class:
*
Academic Class:
*
Date(s) of Leave: (From)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
(To)
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Leave:
*
[Tick if applicable] Leave application submitted to school:
Parent's/Guardian's Name:
*
Contact Number:
*
Format: (000) 000-0000.
Signature of Parent/Guardian:
*
Date:
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Office Use only:
School Leave Application: [] Approved
Madrasa Leave Application: [] Approved
Condition For Leave, if any:
Academic Administrator Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Muhtamim Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: