subject_line
189 South Norwood Hill, London, SE25 6DJ
Telephone 202 8653 0850
Email
registry@spurgeons.ac.uk
Web Site www.spurgeons.ac.uk
Notification of Mitigating Circumstances - MC1 form
First Name
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Middle Name(s)
Last Name
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Email Address
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Programme and year of study
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0/255 characters
1. Please describe the nature of the circumstances or events thathave affected or
are affecting your performance or ability to submit coursework by the deadline:
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2. Dates of periods affected:
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3. Please indicate the units you are requesting an extension for below. You may indicate up to 6 pieces of work. Please complete all fields for each individual assignment.
Unit Number
Unit Name
Due Date
1.
Unit Number
Unit Name
Due Date
2.
Unit Number
Unit Name
Due Date
3.
Unit Number
Unit Name
Due Date
4.
Unit Number
Unit Name
Due Date
5.
Unit Number
Unit Name
Due Date
6.
Unit Number
Unit Name
Due Date
Have you submitted the coursework affected?
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Yes
No
4. The normal extension is two weeks; is that enough in your case?
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Yes
No
How long do you require your extension to be?
5. Are any of your examinations affected?
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Yes
No
Which examinations are affected?
Examination Code
Title
Date of examination
Did you attend your exam (if it has taken place already)? YES or NO
If you are applying before your exam, do you think you will be able to attend it? YES or NO
1.
Examination Code
Title
Date of examination
Did you attend your exam (if it has taken place already)? YES or NO
If you are applying before your exam, do you think you will be able to attend it? YES or NO
2.
Examination Code
Title
Date of examination
Did you attend your exam (if it has taken place already)? YES or NO
If you are applying before your exam, do you think you will be able to attend it? YES or NO
3.
Examination Code
Title
Date of examination
Did you attend your exam (if it has taken place already)? YES or NO
If you are applying before your exam, do you think you will be able to attend it? YES or NO
6. SUPPORTING DOCUMENTATION. It is essential that any documentation is attached. Please tick the relevant box(es):
*
Letter from medical practitioner
Letter from Church leadership
Police report
Other (please specify, e.g. documentation supplied previously):
Other (please specify, e.g. documentation supplied previously):
Please upload files here
I confirm that all information given or referred to above is true. I believe there has been a significant adverse effect on my performance as a result of the circumstances and/or events described.
Signature
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clear
Name (please print)
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Date
*