Exceptional Factors Submission

Thisformisforstudentsseekinganextensionoranotherassessmentopportunityfortheirsummative assessments,astheirperformancehasbeenimpactedduetoExceptionalFactors.FullsupportguidanceontheExceptionalFactorsprocedure and information on the University Assessment Regulationscan be found at the followinglink:

Ifyourequirefurtheradviceand guidance,pleaseseeaStudent SupportOfficer or visit theStudent UnionAdvice Centre.

Step1. PleasefillinyourPersonalDetailsbelow.Pleasecirclewhereappropriate.

Name: / MMUID:
CourseTitle: / ContactNumber:
AttendanceMode?FullTime / PartTime / DistanceLearner / WithoutAttendance
DoyouhaveaPersonalLearningPlan? / Yes / No / Year:

Step2-Whatareyouapplyingfor? PleaseTick

Ineed anextensiontoapieceofwork.
Icannotcomplete/attendtheassessment.Iwanttodeferitforre-assessment.

Step3-Whatpiecesofworkdoesthisapplyto?

UnitTitle / UnitCode* / TypeofSummativeAssessment** / TitleofWork / DateDue

*ThecodecanbefoundinMoodlenexttoyourUnittitles

**TypeofSummativeAssessmentcanbeCoursework,Examination,ClassTest,Presentation,Practical,orLabTest

PanelUseOnly
SubmissionDate(Stamp) / Outcome
SignatureofChair / Date

Step4-Pleasetellusofyourcircumstancesbyincludingasupportingstatement.

Itisessentialthatyoudescribeonaseparatepieceofpaperthefullnatureofcircumstancesaffectingyouandinclude thiswiththeform.Thiscanbetypedorwritten.Explainhowthe circumstancesaffectedyourperformanceintheassessment(s)identified(e.g.timewaslost,concentrationwasaffected,ataskcouldnotbecompleted,etc.)

Step5-Includeevidencethatsupportsyourcase.

Itisessentialthatevidenceisincludedtosupportyourclaim;e.g.ifyouaresubmittingonthegroundsofamedicalconditionthenevidenceoftheconditionwillbenecessary.IfdocumentaryevidencecannotbeobtainedpriortothesubmissionoftheExceptionalFactorspleaseidentifyintheStep4statementthedatebywhichthisinformationwillbesubmitted(normallythisshouldnotbemorethan5workingdays).Youshouldsubmitthisevidenceseparatelyassoonasitisobtained.Rememberifyoufailtoincludeevidenceorevidenceisdeemedlateyourapplication willberejected.

Step6-Contributionbymembersofstaff.

Ifyou feelthataspecificmemberofstaffcancontributetoyourclaimthenyoucanaskthemtowriteasupportingstatement.Thisstepisoptional.

Messagetostaff-Ifastudenthasdiscussedthisclaimwithyouandhasaskedyoutocommentinwriting,andifyouhavesufficientknowledgetohelpevidencethisclaim,pleasewriteortypeasignedstatementtobeincludedwiththeform.Aprintede-mailisalsoacceptable.

Step7-SigntheSubmissionStatementandsubmittheformtothe StudentHubeitherinpersonorelectronically.YournearestStudentHubcanbefoundhere:

(a)Confidentiality

InaccordancewiththeData ProtectionAct1998,weare requiredtogainyourconsent tothefollowing:-

•Toholdsomeelementsoftheinformationyouhaveprovidedonanelectronicdatabase;

•Todisclose the information that you have provided to authorised members of the University staff asrequired forthereasonablepurposesconnectedwiththeinvestigationinthecaseofanAppealorComplaint.

Bysigninghere,youconfirmthatyouagreewiththeabovestatementsandindicateyourconsentfortheinformationprovidedtobeusedasdetailedabove.

(b)FalseClaims

Youshouldnotethatthesubmissionofafalseclaimorfraudulentdocumentationisaseriousmatterandisanacademicoffence,whichwillbedealtwithundertheUniversity’sStudentDisciplinaryProcedures.TheUniversity reservestherighttocheckonthevalidityofthedocument(s)submittedbycontactingthethirdpartydirectly.

Iagreewiththestatementscontainedin(a)aboveandconfirmthattheinformationwhichIhavegivenistrueandthatIhavereadandunderstoodtheProceduresfortheSubmissionofExceptionalFactors.

Your Signature……………………………………………………………………………… Date…………………......