Application for Leave from
FACULTY OF EDUCATION & ARTS – PROFESSIONAL EXPERIENCE UNIT
Personal Details (Please Print)
Phone: Student Number:
Name of School/Service currently attending:
First Date of Leave ……../…..../….... Last Date of Leave ……../…..../…....
Number of School Days: Nature of Leave: (sick, study, maternity, etc)
Reason for Leave:
SUPPORTING EVIDENCE IS REQUIRED IN ALL CASES TO SUPPORT APPLICATION FOR LEAVE (please tick )
If you unable to provide supporting evidence please complete the Statutory Declaration provide on the reverse side of this application.
Doctor’s Certificate Doctor’s Name:
Statutory Declaration (see reverse side of this application)
Other Please specify:
2 & 3 Year Preservice Teachers: Before completion of professional experience the Preservice Teacher
is to liaise with school practicum coordinator to make up ALL absent days. Absences of 3 or more days must
be made up consecutively.
Interns: If absent for a total of 4 or more days over the whole internship then ALL days must be made up
immediately following the prescribed internship period.
Absent days will be made up on:
Coordinators signature: Date:
Students signature: Date:
PLEASE FORWARD THIS FORM TO: Professional Experience Unit
HA80 Hunter Building
The University of Newcastle
CALLAGHAN NSW 2308