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Extenuating circumstances form

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Before completing this form, please ensure you have read the Extenuating Circumstances procedure. You must complete all sections of this form before submission.

This form must be completed by the student and submitted within 7 days of an affected examination or before the affected coursework/dissertation/project deadline.

Advice on how to complete the form can be found on the Students Union webpages.

Read the Extenuating Circumstances Policy and Procedures guidance

  • Your details
  • Are you
  • Are you a distance learner?
  • Are you a Tier 4 Visa holder?
  • Does this EC claim relate to a disability (or long-term condition) already covered by a Support Plan?
  • 1. Please indicate why the form is being completed by selecting the appropriate box or boxes:
  • 3. What work or assessment was affected?
    If there are multiple elements of assessment in the module that you are claiming for, please specify in the Module Title box which part your claim relates to. For example, by giving the assignment name.
  • 4. What evidence are you providing in support of your claim?
  • Will supporting documentary evidence be submitted separately?
  • Your supporting evidence

    Upload up to four supporting documents. The University reserves the right to request sight of original documents if necessary

    In accordance with the Guide to the General Data Protection regulations, you should only submit evidence (data) relating to living third parties if it is strictly necessary for the consideration of your claim e.g. details of a relative’s hospital admission, a police report concerning a family member or partner. Due to the volume of EC claims processed, the University may be unable to contact people named in your claim to advise them that the University is holding data about them. You should make anyone whose data you are including in your claim aware that you are doing so in order that, if they wish to do so, they can contact the University to object to that data being held.

    You can upload documents of these sorts: doc, docx, eml, jpeg, jpg, msg, pdf, png, rtf, xls and xlsx, up to a total maximum of 20Mb.

    You will have the opportunity to send more attachments after submitting the form.

  • 5. Although it isn't mandatory for you to speak to someone before you submit a claim, staff members can provide helpful advice, if needed. If you've been speaking to someone about the circumstances affecting your study, it can be helpful for the Panel to know this.
  • Outcome
    In order to support you in making this claim, we need you to tell us what outcome you are expecting for every affected assessment. Potential outcomes are: waive late submission penalties, extension to submission deadline (please indicate your requested new submission date), further first sit attempt, further reassessment attempt, annul and repeat the affected year/semester (for this outcome tuition fees would be payable). This is for indicative purposes only, and your School or Department has the final decision as to what action will be taken.
  • Student signature and consent
  • The information I have provided is correct and complete to the best of my knowledge. In submitting this form I given my consent for this information to be disclosed to relevant Examiners and Officers of the University responsible for considering my claim. I understand that the claim will be kept on my University record. Please note, whilst all applications will be treated with appropriate confidentiality, details may be shared with welfare colleagues, who may need to contact you directly to offer advice and support if the information disclosed is of significant concern.