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UTTARANCHAL COLLEGE OF SCIENCE & TECHNOLOGY

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Name of the applicant (in BLOCK letters): .................................................. Faculty ID : Designation: . Department: .. Nature From (o No. of Days

Academic Year:. 1. Nature !eriod of "ea#e (For $"%&"%A"%'"%!" etc. please attach supporting papers) ). *olidays+ !refi,ing % -uffi,ing .. /easons for lea#e 0. Address 1hile on lea#e !refi, -uffi,

From: From:

(o: (o:

No. of Days: No. of Days:

$ontact !hone No. (if any):

&mail:

Date /ecommended % Not recommended

-ignature of the applicant

*2D % !rogram $o3ordinator Name: For Office use only $ausal "ea#e%&" A 6 $ "ea#e a#aila5le 5efore this application "ea#e applied for 6alance "ea#e 'aternity % !aternity "ea#e Academic "ea#e (conferences% seminars% 1or4shops% short3 term courses) Duty "ea#e (data collection% Admission 1or4s%etc.)

Appro#ed % Not appro#ed % For1arded to .. Date: -ignature of the Director%'D

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