SIGNED : ____________________________________ DATE : ___________________ HEAD OF SCHOOL/DIRECTOR OF INSTITUTE Please send copy of form to : Ms Katharine Rogers Director of Faculty Operations Faculty Office Faculty of Medical Sciences Newcastle University Medical School Framlington Place NE2 4HH Reviewed by FSG: YES NO Approved on behalf of FSG __________________________________ SIGNATURE Date: ___________________________________ PRINT NAME Data Protection statement: The University will process the data provided on this form in accordance with the HR privacy notice which can be found on our website at
SIGNED : ____________________________________ HEAD OF SCHOOL/DIRECTOR OF INSTITUTE DATE : ___________________ Please send copy of form to : Ms Katharine Rogers Director of Faculty Operations Faculty Office Faculty of Medical Sciences Newcastle University Medical School Framlington Place NE2 4HH Reviewed by FSG: YES NO Date: Approved on behalf of FSG __________________________________ SIGNATURE ___________________________________ PRINT NAME Data Protection statement: The University will process the data provided on this form in accordance with the HR privacy notice which can be found on our website at
academic-leaver-checklist-amended-may-2018.docx