BHARATHIDASAN INSTITUTE OF TECHNOLOGY BHARATHIDASAN INSTITUTE OF TECHNOLOGY

ANNA UNIVERSITY ANNA UNIVERSITY

TIRUCHIRAPPALLI – 620024 TIRUCHIRAPPALLI – 620024
LEAVE APPLICATION FORM (TEACHING STAFF) FOR CL / RH / CPL / SCL/ OD
LEAVE APPLICATION FORM (TEACHING STAFF) FOR CL / RH / CPL / SCL/ OD (Leave cannot be claimed as a matter of right)
(Leave cannot be claimed as a matter of right)
DATE OF APPLICATION NAME OF THE DEPARTMENT YEAR: 2023-2024
DATE OF APPLICATION NAME OF THE DEPARTMENT YEAR: 2023-2024 SEMESTER : ODD / EVEN
CSE/IT
SEMESTER : ODD / EVEN
CSE/IT 1. Name :

2. Designation :
1. Name :
3. Mention Nature of Leave :
2. Designation :
4. No. of Days already availed :
3. Mention Nature of Leave :
5. No. of Days and period for which
4. No. of Days already availed : Leave is required with date :

5. No. of Days and period for which 6. Purpose for which leave is
Leave is required with date : Required :

6. Purpose for which leave is 7. Address while on leave &

Required : contact phone numbers :

7. Address while on leave & 8. Alternate Arrangements :

contact phone numbers :
Name & Signature of
8. Alternate Arrangements : Date Hour Class Subject the faculty taking the
classes
Name & Signature of
Date Hour Class Subject the faculty taking the
classes

Signature of the Staff Recommended / Not Recommended

DEAN Head of the Department

Signature of the Staff Recommended / Not Recommended

Head of the Department

DEAN