APPLICATION FOR APPROVED ABSENCE

This form shall only be used to apply for approved absence of class. If examination or assessment
are affected, students must use Exceptional Circumstances form to claim.

This form is part of the procedure No. AC-PD-08/12/2019 – BUV on student approved absence.
• For absence due to family issues, students are required to submit this form in advance.
Retrospective applications will not be considered.
• For absence due to medical, incident or unavoidable issues, students must submit this form
with evidence within 03 working days after returning to university.
Student name: ______________________________Date of birth: ___________________________
Student ID number: __________________________Cohort/Class: ___________________________
Email: _____________________________________Mobile number: ________________________
Details of absence(s) as below:
Date(s) Module Absent Name of teacher/
hour lecturer

Please kindly describe clearly the reason for your requested absence:
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………………………………………………………………………………………………………………………………………………………….
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Approved absence application form – Version 2.0 - Updated 3 Feb 2021 – Approved by Deputy Chief Academic Officer
□ Submitted Evidence:
1……………………………………………………………………………………………………………………………………………………….
2……………………………………………………………………………………………………………………………………………………….
3……………………………………………………………………………………………………………………………………………………….
4……………………………………………………………………………………………………………………………………………………….
5……………………………………………………………………………………………………………………………………………………….
I hereby certify that the information provided above is true. I understand that providing false
information and evidence to the Student Support Officers is Academic Misconduct and may affect
my entitlement to take assessments for the respective module(s).
Student’s signature
________________________________________________________Date_____________________

OFFICER PART

Received by (SSO)__________________________________________________________________
Date____________________

SSO Note: ________________________________________________________________________

Date____________________

Academic Compliance Manager Comment: ______________________________________________

_________________________________________________________________________________
Date____________________

Programme Leader’s Approval _______________________________________________________

Date ___________________

Note: This form is a request and is only valid and granted if agreed and signed by your Programme Leader.
Copies of this form are sent to the authorised parent / fee payer if requested. Please complete this form
carefully as it will form part of your student file and is available to authorised persons requesting references
on your academic performance.

Approved absence application form – Version 2.0 - Updated 3 Feb 2021 – Approved by Deputy Chief Academic Officer