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BIRLA INSTITUTE OF TECHNOLOGY AND SCIENCE, PILANI

K.K.BIRLA GOA CAMPUS


Student Welfare Division
APPROVAL FOR LEAVE FOR ATTENDING CONFERENCE/WORKSHOP
____________________________________________________________________________________

Date: ___________________

1. Name of the student: ____________________________________________________________

2. Id. No:_____________________________ Contact No: _____________________________

3. Department:_____________________________________________

4. Name of the conference you have been selected for(enclose proof):_______________________


______________________________________________________________________________

5. Place of the conference: __________________________________________________________

6. Duration of Conference: FROM______________________TO_____________________________

7. Nature of your participation(give a tick): Paper Presentation( ) Giving an invitation Talk ( )


Just Participation

8. Period of your visit (Leave from Institute): FROM ________________ TO_____________________

9. Are you getting any Financial support from the conference organizers? Yes( ) No( )

Declaration: I hereby declare that the above information is true to the best of my knowledge. Also I will
be responsible for Examinations and all other academic requirements that I will miss during my leave.

____________________

Signature of the student

Note: Attach all the supporting documents.

Forwarded by HOD:

Associate Dean, AUGSD Associate Dean, SWD

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