Exceptional Factors Submission

Thisformisforexceptional factors submissions relating to examinations that were heldon or afterTuesday 23 May. Any other exceptional factors submissions should be made on the standard exceptional factors submission form (EF1 Form). 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–Which examination(s) does this submission relate to?

UnitCode / Unit Title / Exam Date

Step3–Please indicate below the reasons for this submission?

Please tick

I experienced travel difficulties during the week commencing 23 May 2017
I was adversely affected in other ways by events in Manchester on 22/23 May 2017

If you wish to provide any further information, please do so below:

PLEASE NOTE: YOU WILL NOT BE REQUIRED TO SUBMIT ANY SUPPORTING EVIDENCE

Step4-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.

IagreewiththestatementscontainedaboveandconfirmthattheinformationwhichIhavegivenistrueandthatIhavereadandunderstoodtheProceduresfortheSubmissionofExceptionalFactors.

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

PanelUseOnly
SubmissionDate(Stamp) / Outcome
SignatureofChair / Date