JAYAWANT SHIKSHAN PRASARAK MANDAL’s
JAYAWANTRAO SAWANT POLYTECHNIC
( Sr. No. 58, Handewadi Road, Hadapsar, Pune- 28.)
Academic Year ____________
Date: / /
Student Leave Application
From,
Student Name:_____________________________________ Class and Division:__________ Roll No………
Student Contact No.:…………………………………Father/Mother Contact No.:………………………………
To,
The HOD,
Name of Department:
J. S. Polytechnic, Hadapsar, Pune-28.
Respected Sir/Madam,
I request you to please grant me the leave from date…….…….to date………… total days ............
Reason for the leave
____________________________________________________________________________________________________
_____________________________________________________________________________________________________
______________________________________________________________________________________________________
Promised that,
a. I will maintain the attendance as per rules and regulation of the MSBTE.
b. I will complete my work given by subject teacher during my absent period and report to
GFM
Sign of Student Sign of GFM
Sign of CT Sign of HOD
Remark: Approved / Not Approved