Tanghalang Lykeion Leave Form

Name of Member:______________________________________ Date Filed:_______________

Section / Course: ____________________ No. of Filing: __________________

REASON FOR LEAVE

Sick Leave (Attach medical certificate or proof of illness)

Emergency Leave (Attach a letter explaining the situation and evidence)
Special Leave (Academic commitments and activities related to religious affiliations are
considered for this type of leave. The member must give notice to the Adviser before using a
Special Leave.)
Others (please specify): _______________________________

Narrative Reason for Leave: (Required)

______________________________________________________________________________
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Start of Leave: _________, ___, 20__ Until: _________, ___, 20__

General Agreement:
 Requests for academic leave are only allowed to Members. If a member requests a leave of
absence, they must file a “TALA leave form” 1 week or 24 hours before an activity. Members
also have to provide proof of their academic leave of absence. 
 Academic leave of Absence is only viable for 3 files per semester. Surpassing the 5 day limit will
result in termination of membership. 

____________________________________
Signature over Printed Name and Date

ADVISER’S COMMENTS

Comment:
______________________________________________________________________________
_____________________________________________________________________________________

APPROVED DISAPPROVED

_________________________

Ms. Diosary Narvaez Timbol

Adviser, Tanghalang Lykeion

By affixing both parties’ signature on this form, it is hereby acknowledged and certified that the terms and
conditions of the filing of leave were reviewed thoroughly and will take effect on the date approved.