Extenuating Circumstances Form by brokeNCYDE

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									CARDIFF SCHOOL OF HISTORY & ARCHAEOLOGY
HISTORY & WELSH HISTORY
              SPECIAL / EXTENUATING CIRCUMSTANCES REPORT FORM
SECTION A: STUDENT DETAILS
Name
Student Number
Year of Study
Degree Scheme
Personal Tutor
List of modules affected:

1. HS________

2. HS________

3. HS________

4. HS________


SECTION B: PLEASE SELECT ONE/OR BOTH OF THE FOLLOWING:

I am requesting that my special circumstances be taken into account by the Examining Board

I am requesting a revised submission date for a piece of coursework
(Please complete an essay extension form)

SECTION C: SPECIAL CIRCUMSTANCES
My special / extenuating circumstances are (please tick as appropriate)

 Ill Health                                          Maternity

 Compassionate Grounds                               Parental Leave / Responsibilities

 Exceptional Professional Commitments                Financial Hardship

 Other Grounds:




SECTION D: DURATION OF SPECIAL / EXTENUATING CIRCUMSTANCES
Please give the period of time you have been affected by these circumstances (these should be
confirmed in the supporting documentation):

From:                                             To:
SECTION E: DETAILS OF SPECIAL / EXTENUATING CIRCUMSTANCES
(continue on a separate sheet if necessary OR attach a letter):




SECTION F: EVIDENCE SUBMITTED
I am submitting the following evidence to support my request for special / extenuating circumstances.
(Please specify and attach securely to this form e.g. letter from doctor, student counsellor, personal tutor):




SECTION G: DECLARATION
I declare that the information given above is factually correct and may be disclosed to members of the
Extenuating Circumstances Sub-Group.

Signed:

Date:


    ALL COMPLETED SPECIAL / EXTENUATING CIRCUMSTANCES FORMS SHOULD BE
  SUBMITTED TO MARINA PETERS, SCHOOL OFFICE, CARDIFF SCHOOL OF HISTORY AND
                                ARCHAEOLOGY
   Notes about the Special / Extenuating Circumstances Report Form
This form is to help you report any special or extenuating circumstances that you may have
encountered, but a completed form is not mandatory for History to take into account any
circumstances that have affected you provided they have been reported to us (i.e. a Personal Tutor)
in some form.

1. It is your responsibility to report any significant personal circumstances that, in your opinion, had or
will have a substantial impact on your performance in coursework or examination.

2. In accordance with University procedures, a n Extenuating Circumstances Sub-Group will consider
the form and any documentary support submitted. This is a small sub -group of the History and Welsh
History Board of Examiners.
    • No personal details – only summary recommendations – will be disclosed to the wider Board
        of Examiners.
    • All details are treated in the strictest confidence.

3. Do not list all modules that you have studied – only those that you feel were adversely affected by
your special / extenuating circumstances. Be precise about what assessments were affected – e.g.
essays, exam, etc.

4. You must be specific about, e.g. the unforeseen and unavoidable personal circumstances that
significantly affected your performance. Be precise about how your work was affected – e.g. lack of
time to complete the work, missed X hours in the library, unable to revise, etc. The more detail you
provide to indicate the severity and impact of the circumstances, the greater will be the information
available to assist the Sub-Group in considering your case. You may use additional sheets of paper if
necessary. You must indicate how long the problems lasted.

5. If the circumstances are particularly sensitive, exceptionally, it may be appropriate to submit the
form in a sealed envelope, marked as ‘strictly confidential’ and ‘for the attention of the Chair of the
Board of Examiners only’.

6. You are advised to provide documentary support about the problems and the period of impact –
e.g. doctor’s notes, a statement of support from your tutor, etc. It is recognised that this is not always
possible, but you need to be aware that your case is more likely to be considered as ‘strong’ if
documentary support is available.

7. In most cases, students will be expected to have informed their Personal Tutor (or other member
of academic staff), the Senior Tutor or the Head of Section that their study has been affected by
special / extenuating circumstances.

								
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