COPP LEAVE NOTIFICATION FORM

COPP LEAVE NOTIFICATION FORM
Name of Intern

First NameLast Name
Date of Application

DayMonthYear
Date
Name of Principal Supervisor

First NameLast Name
Intern Email*
example@example.com
Note:

· Leave may be taken for any period longer than 4 weeks (1 month) when an intern is not working in their approved placement.

· Leave cannot be taken from COPP while an intern continues to work in their placement.

· For leave longer than 8 weeks the intern must also advise AHPRA directly of their leave in addition to completing this form.
Leave Type
Leave Explanation
Leave Period
Start Date

DayMonthYear
Date
Return Date

DayMonthYear
Date
Will you be working in your AHPRA approved role during the period that you have requested leave ?

YesNo
receipient1
example@example.com
Approver
example@example.com
Should be Empty: