Please complete this form using a word processor, or use a pen and write in block capitals if completing by hand using the following PDF

You are required to submit supporting documentary evidence. Applications submitted without supporting documentary evidence will not be considered. Please see the Student Guidance Booklet on Extenuating Circumstances for guidance on the requirements for documentary evidence:
http://www.welfare.qmul.ac.uk/documents/leaflets/extcircs/5069.pdf

You must submit the completed form to Rosine Smyrl who is based in the Bancroft Building room 124 (Language Centre Office). Please contact Rosine on email: r.smyrl@qmul.ac.uk or telephone: 020 7882 2826 to arrange an appointment when she will be able to go through your submission with you and explain the application procedures. Please do NOT contact your Senior Tutor.

You are reminded that the College operates a 'fit-to-sit' policy.  If you are not fit to sit an examination or submit coursework, you MUST NOT attempt to sit the examination or submit the coursework but you should obtain the necessary medical or other evidence and apply for extenuating circumstances so that you may be given another opportunity.  If you sit an examination or submit coursework you may not normally apply for extenuating circumstances for that assessment as by sitting that assessment you have declared yourself 'fit-to-sit' and the mark that you have obtained for that module will stand.

All applications for extenuating circumstances are treated in the strictest confidence.  Students must submit applications WITHIN THREE WORKING DAYS of the event/incident occurring. Applications submitted after this deadline will only be accepted if the candidate can demonstrate a good reason for the delay. The final deadline for submission of all claims for extenuating circumstances for 2011/12 is TUESDAY 12 JUNE 2012.  Applications submitted after the final deadline will not be considered at all.

Please note all applications for extenuating circumstances must be considered at the Examination Board. This means that you will not be informed of the outcome of your application until after the Examination Board has met. You will receive the outcome of your application when your confirmed examination results are published in MySIS.

For further information about extenuating circumstances and the Examination Board procedure, please consult the School’s Examinations FAQ:

http://qm-web.sllf.qmul.ac.uk/examfaq.shtml