Request for leave during practicum Bachelor of Education/Graduate Diploma

Before submitting/reviewing this application, please refer to the Practicum Handbook information regarding applications for leave.
This application is to be completed for absences from practicum in good time PRIOR to the event.
When it is not possible to apply for leave prior to the event, this form must be submitted as soon as possible.

Student first name

Student last name

Student ID

University email address

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Practicum centre/school

Associate teacher name (Prim/ECE students only)

Professional Supervisor name

Associate teacher email address (Prim/ECE students only)

I am requesting leave from practicum

Please enter your practicum course code

Leave start date

Leave end date

Total number of hours or days requested

Please specify number of hours or days

I require this leave because

Evidence to Support this Request for Leave from Practicum

Upload file

Please convert to PDF before uploading

Please do not enter any credit card information into this form.