Universiti Tunku Abdul Rahman

Form Title : CLASS REPLACEMENT FORM

Form Number : FM-CFS-PK-05

Rev No: 1

Effective Date: 22/06/2011

Page No: 1 of 1

STUDENTS DETAILS
Name
Gender *
Name of Guardian

Student ID
Tel no
Contact no

Male / Female

CLASS REPLACEMENT DETAILS

Actual class
Replacement class

Type (eg: P20 or T4)

Time (eg: 1500-1700)
Type (eg: P15 or T6)
Time (eg: 1500-1700)

Date
Tutor/Lecturer
Date
Tutor/Lecturer

REASONS (Please provide detailed explanations with supporting documents, if necessary)

CLASS REPLACEMENT HISTORY

Any previous application before this :

Yes / No *

(If yes, please provide details below)

Reasons for previous

application

VERIFICATION BY ORIGINAL LECTURER

Name
Date/Time
Remarks (if applicable)

______________

Signature
VERIFICATION BY LECTURER OF REPLACEMENT CLASS
Name
Date/Time
Remarks (if applicable)
______________

Signature
* Delete which is not applicable

Note: 1. Please obtain your original lecturers approval and signature before attending your
replacement class. This form is to be submitted to your original lecturer within two
days after your attendance is duly verified by the replacement lecturer.
2. I understand that my original lecturer reserves the right to mark me as absent
since I actually did not attend his/her class.

____________________

________________

Students Signature
Name:

Date: