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Mitigating Circumstances Form

This form is for students to submit evidence of circumstances like health issues or personal problems that affected their academic performance or ability to meet deadlines. Students must describe how the issues disrupted their studies and provide supporting documentation. The faculty will review the information confidentially to determine whether an extension or other consideration is warranted.

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Katlo Botho Mokoba
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24 views3 pages

Mitigating Circumstances Form

This form is for students to submit evidence of circumstances like health issues or personal problems that affected their academic performance or ability to meet deadlines. Students must describe how the issues disrupted their studies and provide supporting documentation. The faculty will review the information confidentially to determine whether an extension or other consideration is warranted.

Uploaded by

Katlo Botho Mokoba
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Mitigating Circumstances Form

This form is for students submitting evidence of medical or personal circumstances that they
wish to be considered in relation to:
● to explain absence from an examination;

● to explain the failure to submit work, or to submit work on time;

● to support a request for an extension to a submission deadline, or to defer


assessment;
● to explain cases where the student’s academic performance falls below
expectations.
Mitigating circumstances must be:

● significant, meaning that they should have a clearly detrimental effect on


the student’s academic work; and
● relevant, meaning that they must relate directly to the timing of the
class, assessment or deadline in question; and
● outside the student’s control, meaning that the effect could not be avoided,
counteracted or reduced by the student taking reasonable steps in the
preparation or in response.

Please submit your mitigating circumstances form to the Administration Office.

Student Name (Last Name, First


Name):
Student Number:

Date of Birth:

Program of Study:

Length:

Reason
□ Program issues
□ Health

□ Financial □ Accommodation issues

□ Gone into employment □ Personal


□ Other
Please describe below the relevant personal circumstances of the applicant, outlining how these
have disrupted his/her studies:

Supporting Documentation: Please list all supporting documentation that you are
sending with this form

Student Declaration: By submitting this form I confirm that all the information contained
in this statement is accurate and complete to the best of my knowledge. I consent to the
information being used by the faculty member in the consideration of the deadline
extension request and understand that the information will be treated in the strictest
confidence.

The maximum extension granted is eight weeks.


(Student Guidelines 4.11.4 EXTENSIONS TO ASSESSMENT DEADLINES)

Student Signature:

Date:

For Administration only

Academic Approval

Academic Dean /Managing Director

Comments

Signature Date

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