PGR Paid Medical Leave Form

All absences of 29 days or more (unless covered by Authorised Absence): You must also apply for Temporary Withdrawal from the University.

Student visa holders must comply with the conditions of their visa at all times. If you are applying for paid medical leave, please be aware of the following requirements regarding absence from study. Please always seek advice from the Student Visa Advice Service to ensure compliance:

Absences of 8 days or more: You must also apply for Authorised Absence.
Absences longer than 42 continuous days: You may be required to apply for Temporary Withdrawal.

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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

Accepted medical certification must:

Originate from a medical professional or service
Identify the funded PGR student by name
Be signed (electronic signatures are accepted)
Be in English
Must state that the identified student is unfit to work or study
Cover the entire duration of the period of Paid Medical Leave and must explicitly state the start date and duration of the absence

Medical evidence

Attach file

No files are currently attached.

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

I confirm that if my period of absence is 29 days or longer (8 days or longer for student visa holders) I will also submit a temporary withdrawal/authorised absence request as necessary.

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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