LADY SHRI RAM COLLEGE FOR WOMEN LADY SHRI RAM COLLEGE FOR WOMEN

(UNIVERISTY OF DELHI) (UNIVERISTY OF DELHI)

LAJPAT NAGAR-IV, NEW DELHI – 110 024 LAJPAT NAGAR-IV, NEW DELHI – 110 024

ECA/MEDICAL/NCC/NSO/NSS FORM ECA/MEDICAL/NCC/NSO/NSS FORM

Name of the Student _________________________ Roll No. ____________ Name of the Student _________________________ Roll No. ____________

Course ______________________________ Section __________________ Course ______________________________ Section __________________

No. of days for which leave required ________________________________ No. of days for which leave required ________________________________

Date: From _______________________ To __________________________ Date: From _______________________ To __________________________

Reason for Leave ________________________________________________ Reason for Leave ________________________________________________

Sl. Name of the Tutor No. of Tutor’s Signature Sl. Name of the Tutor No. of Tutor’s Signature
No. Lectures held No. Lectures held
1 1
2 2
3 3
4 4
5 5
6 6
7 7
8 8
Total No. of Lecture Held Total No. of Lecture Held

Countersigned Countersigned

Student’s Signature Student’s Signature

Father/Guardian Mob.: ________________________ Father/Guardian Mob.: ________________________

Address _______________________ Address _______________________

______________________________ ______________________________