PGR Paid Medical Leave Form

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Uni ID

Full name

Enter a brief description of your reason for submitting this form

First date of Absence

First Date of Return

Medical Certification & Supporting Documentation

Attach file

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I confirm that this absence specifically relates to a disability or medical condition that is already disclosed to the University of Warwick, therefore additional medical certification is not required to be provided with the form.

I hereby certify that I am the above named person.

I have read the policy regarding paid medical leave

Please select your current source of funding

Privacy notice

The data on this form will be used to verify your identity and used to process your claimed period of absence. It will be held securely for the duration of your studies. We will send you the outcome of the request to your University of Warwick email account. We will store the fact that you have requested this period of leave to ensure our records are correct. We will not use the data for any other purpose.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.

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