Reference Number

Eligibility Assessment of Attendance

Student Registration Number 6

2 2 5 5 2 E
Name of the Student S. M. D. Kumarasekara
Contact Number 0 7 1 5 5 9 1 4 3 6
Current Semester Batch 22 Level 1 Semester 1
Degree Program BSc Hons in Artificial Intelligence

Nature of the
Module Date Missed Academic Informed to
No Module Title Time
Code (dd/mm/yyyy) Activities Lecturer in Charge
(Lecture/Tutorial/Lab)

1 IN1321 Computer Organization 11/10/2023 8.15 - 10.15 am Lecture No

2 IN1321 Computer Organization 18/10/2023 8.15 - 10.15 am Lecture No

10
 1
Supportive Documents :
Medical Documents are attached with this document.
…………………………………………………………………………………………………………………………………………………………………………………………………………………........................................

…………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….....

1. I understand, accept and agree to take the responsibility to cover any missed academic activities during my absence.
2. I have reviewed my application and certify that everything I have stated is true.

Date (dd/mm/yyyy):
………………………………………….
2 9 / 1 1 / 2 0 2 3
Signature of the Student

2
Confirmation of Authorized Person (Only for leave on Medical or Official Representation Ground)
Recommended / Not Recommended
Remarks / Reasons3:
Date (dd/mm/yyyy):
………………………….................
Signature of Authorized Person / /
.
For Department Use Only
Number of days falling in semester period given by the student is correct / incorrect
Request is Recommended / Not Recommended
3
Remarks / Reasons :
Date (dd/mm/yyyy):
………………………….................PGS Upeksha
Signature of Academic Advisor
. 2 9 / 1 1 / 2 0 2 3

Notes:
1. Use a separate sheet for additional information and attach supporting documents as applicable and mention the documents type here
2. Relevant Officer-In-Charge (e.g. Director Physical Education for sports events)
3. Please write legibly, state and use a separate sheet if more space is required