Department of Mathematics and Applied Mathematics
Faculty of Science
Sick test application form
Student information:
Student number:
Surname:
Initials:
Contact number:
Preferred email address:
Current address:
Module and semester test information
Module code:
Semester test date:
Reason for absence
List of supporting documents submitted
Witness information (Please provide the contact information of a person who can verify the reason for your absence.)
Name and surname of person who can verify the reason:
What is your relationship to that person:
Contact number for that person:
Email address of that person: