AGES Accredited Training Program (AATP) Extended Leave of Absence

AGES fellows should consider (when making leave applications) that AGES is not an employing body and that whilst AGES offers places in the AATP training program, AGES is not able to guarantee any employing hospital or Training Unit will approve any leave request made.

For more information please refer to the AGES Accredited Training Program (AATP) Extended Leave of Absence Policy Statement.

Trainee Details
Trainee Name*
Prefix First Last
Training Unit*
Unit Director*
Prefix First Last
AATP Year Group*
Basis for Leave Request
What is the basis for this leave request?*
Other, please specify*
Anticipated Date Start of Leave*
DD slash MM slash YYYY
Anticipated Date End of Leave*
DD slash MM slash YYYY
Supporting Letter*
Please upload a letter in support of your application (e.g., letter confirmation of the estimated date of delivery)
Max. file size: 64 MB.
Other Supporting Documentation
Please upload any other supporting information relevant to the request.
Drop files here or

Max. file size: 64 MB.
Signature*
Date*
DD slash MM slash YYYY
Confirmation Email*

You will receive an automated confirmation email once this form has been submitted.
Phone
This field is for validation purposes and should be left unchanged.

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AGES Accredited Training Program (AATP) Extended Leave of Absence

Trainee Details

Basis for Leave Request