Closed business:disclosure would constitute a breach of theData Protection Act

Name of Student / UUN / Programme of Study / Year of Study
No. of Credits attained to date / Year of Study student will return to
Date of Interruption / From / To
Click here to enter a date. / Click here to enter a date. /
Reason for Request
Please provide all the following information or the request will not be considered
Please cross the following boxes:
☐Full academic information completed (complete remainder of this form)
☐Full supporting documentation attached; medical, counselling or other
☐Full support of the student’s Personal Tutor
☐SSO informed
Please note that only in very exceptional cases (e.g. major illness) will a year’s AIS be permitted between the third and fourth years of an Honours programme.
Authorised by
Senior Tutor or UG Director / Position / Choose an item. / Date / Click here to enter a date. /
Signed
Submitted by / Position / Date / Click here to enter a date. /

All enquiries and completed AIS forms to CHSS Academic Administration Office:

; Tel. 651 3900.

College Use Only
Approved /
Not approved
Position / Associate Dean (Academic Progress)
Signed / Date

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Student Name: Click here to enter text.

Matriculation Number: Click here to enter text.

ACADEMIC INFORMATION REQUIRED TO SUPPORT AIS REQUESTS

All the information in both tables below is required before an AIS request can be made. Incomplete forms will be returned.

Unless all issues relating to the crediting of work are addressed below, an AIS will not be granted.

CURRENT COURSES AND CREDITING OF WORK

  • All the courses on a student's EUCLID record for the current academic session must be accounted for below. This includes outside courses and zero-credit courses.
  • Decisions of the Special Circumstances Committee / Exam Board relating to assessment must be included.
  • Once an AIS is granted, it is the School’s responsibility to ensure that the arrangements required for work to be credited are put in place in due course.

Subject area / Course name / Level / Delivery period / Number of credits / List all assessment components for each course and weighting / Identify coursework to be credited and provide marks / Exam marks
e.g. History / British History 1 / 8 / Full Year / 40 / Written Exam 50%, Coursework (4 x 2000 essays) 50% / 2 x 2000 essays: 60%, 63% / 53%

For all courses in which coursework or exams cannot be credited, explain how the shortfall for each course will be addressed:

[e.g. resit / resubmission / alternative assessment / deadlines / mark based on coursework ]

ACADEMIC PROGRAMME TO WHICH THE STUDENT WILL BE RETURNING IF AIS GRANTED

List all the courses which would comprise the academic programme the student would be returning to if an AIS were granted, including outside courses and zero-credit courses.

Subject area / Course name / Level / Delivery period / Number of credits / Elements to be credited via particular arrangements (eg re-sit, work to be completed to a different deadline)

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