Request for an Assessment Deadline Extension due to Exceptional Circumstances** ** Also known as mitigating or unforeseen circumstances QA Ref: STU13; Maintained by: Registry; Last updated: September 2017 GUIDANCE NOTES It is your responsibility to fully and correctly complete the Exceptional Circumstances claim form, and submit this with satisfactory evidence, as set out in the . The form must be completed by you, and cannot be completed by someone else on your behalf. You must submit your claim before your assessment deadline. Claims without satisfactory evidence, or that are submitted after the deadline for claiming, will be declined. Your details (all fields marked * must be completed) Your Name* Student ID* School * Programme of Study* Year of Programme* Semester/Term* Collaborative Partner (if not taught at York St John University) Do you have a YSJU email* Learning Support Plan* Assessment(s) affected* Have you Have you previously Assessment previously been requested an Your Current given a Learning Number and Module Module Module extension for Assessment Support Plan Type Code Title Director unforeseen Date (LSP) extension circumstances for eg 001 Exam for this this assessment assessment? before? Your circumstances* Reason for application for extension as appropriate) Examples of documentary evidence to submit with this form (indicate ‘X’ Unforeseen medical circumstances significant acute Medical certificate or GP letter covering the affected period and the – duration of extension requested illness, accident or injury sudden and severe in nature – Medical certificate or GP letter relating to dependent/family Unforeseen illness of dependents or immediate family member, GP or other independent professional third party evidence confirming how these circumstances are impacting upon you Obituary, and/or order of service; for extensions of longer than 1 Close family bereavement week a death certificate or medical evidence will be required Disability only applicable where there has been a delay Letter/email from the Disability Advice Team confirming the delay in – in arranging a reasonable adjustments and/or support support is beyond your control Deterioration/change in disability or long-term Recent evidence describing the specific deterioration/ change and condition unforeseen deterioration/change in the – the period it applies to eg medical certificate or GP letter condition during the assessment period A police crime number, insurance claim documents, court Victim of serious crime notification, GP letter; the evidence should demonstrate the impact upon you
Request for an Assessment Deadline Extension due to Exceptional Circumstances** ** Also known as mitigating or unforeseen circumstances QA Ref: STU13; Maintained by: Registry; Last updated: September 2017 GUIDANCE NOTES It is your responsibility to fully and correctly complete the Exceptional Circumstances claim form, and submit this with satisfactory evidence, as set out in the . The form must be completed by you, and cannot be completed by someone else on your behalf. You must submit your claim before your assessment deadline. Claims without satisfactory evidence, or that are submitted after the deadline for claiming, will be declined. Your details (all fields marked * must be completed) Your Name* Student ID* School * Programme of Study* Year of Programme* Semester/Term* Collaborative Partner (if not taught at York St John University) YSJU email* Do you have a Learning Support Plan* Assessment(s) affected* Module Code Module Title Assessment Number and Type eg 001 Exam Module Director Your Current Assessment Date Have you previously requested an extension for unforeseen circumstances for this assessment before? Have you previously been given a Learning Support Plan (LSP) extension for this assessment? Your circumstances* Reason for application for extension (indicate ‘X’ as appropriate) Examples of documentary evidence to submit with this form Unforeseen medical circumstances – significant acute illness, accident or injury – sudden and severe in nature Medical certificate or GP letter covering the affected period and the duration of extension requested Unforeseen illness of dependents or immediate family Medical certificate or GP letter relating to dependent/family member, GP or other independent professional third party evidence confirming how these circumstances are impacting upon you Close family bereavement Obituary, and/or order of service; for extensions of longer than 1 week a death certificate or medical evidence will be required Disability – only applicable where there has been a delay in arranging a reasonable adjustments and/or support Letter/email from the Disability Advice Team confirming the delay in support is beyond your control Deterioration/change in disability or long-term condition – unforeseen deterioration/change in the condition during the assessment period Recent evidence describing the specific deterioration/ change and the period it applies to eg medical certificate or GP letter Victim of serious crime A police crime number, insurance claim documents, court notification, GP letter; the evidence should demonstrate the impact upon you