EDR 15

MINISTRY OF EDUCATION
APPLICATION FOR: SPECIAL LEAVE
ED. RULE 84 (3), S.I. 87 of 2012
Application form must be completed in TRIPLICATE and forwarded to the Managing Authority, through
the Principal, not less than two weeks prior to the commencement of such leave.

Procedures: A. APPLICANT’S BIOGRAPHICAL DATA

1. Submission of 1.NAME
completed form
along with evidence Last Name First Name Middle Name
of nomination and 2.SCHOOL
event to Principal.
2. Principal makes 3. DISTRICT
recommendation
and forwards form 4. MANAGING
AUTHORITY
to Managing
B. PURPOSE FOR SPECIAL LEAVE
Authority.
5. State briefly the reason for the request(e.g. annual BDF training, international
3. Managing Authority
sports, cultural event)
verifies particulars
provided in the
application, makes 6. Nominating Institution /
recommendation Organization where
and forwards applicable
application to TSC 7. Venue of the event
for leave exceeding where applicable
10 days. 8. Attach supporting documents to this application form.
4. TSC makes final
determination on 9. Number of days and period for which leave is
Special Leave being requested: ________________days
application. From To
5. Copies 1 and 2 of D M Y D M Y
form returned to C. SPECIAL LEAVE HISTORY for CURRENT SCHOOL YEAR
Managing Authority. 10. Special Leave granted this school ˆ Yes ˆ No
6. Copy 1 of form year?
returned to If YES, for each instance state :
Principal, who (i) Purpose
informs the Period From To:
applicant of the D M Y D M Y
decision. (ii) Purpose
Period From To:
Verification of Details D M Y D M Y
Details are accurate for: D. INSTRUCTIONAL MATERIALS
11. I agree to prepare and ˆ Lesson Plans
Evidence submitted submit the following: ˆ Test(s)
( ) Yes ( ) No ˆ Home Work
ˆ Worksheets
Special Leave History ˆ Other (specify)

() Yes ( ) No

Signature of Applicant D M Y
 FOR OFFICE USE

PRINCIPAL’S
RECOMMENDATION Application Received: By:

D M Y Signature
Instructional ˆ Satisfactory
arrangements made by
this teacher are ˆ Not satisfactory

During the period a ˆ Will not be needed.

replacement teacher
ˆ Will be From: To:
needed
This application for ˆ Supported
Special Leave is
ˆ Not supported

Signature D M Y
MANAGING Application Received: By:
AUTHORITY
D M Y Signature
Particulars for the By:
eligible period of service
as given on this form
have been verified.
D M Y Signature
Special Leave of ˆ Recommended ˆ Not
__________days Recommended
Comments:

Signature D M Y
COMMISSION Application Received:

D M Y
Special Leave of ˆ Approved ˆ Not Approved

_________ days
Comments:

Signature D M Y