Extenuating Circumstances Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Extenuating Circumstances (EC) are defined in the Al-Salam Institute regulations as circumstances that are unforeseen and outside your control and which can be shown to have had a direct and substantial impact on your academic results. This may include an impact on the capacity to study prior to an assessment, on the ability to complete an assessment, and/or on performance during an assessment.

Guidance and Criteria

Your statement will be judged by the Al-Salam Institute EC Panel who will make a decision whether you will be allowed additional time to complete your assignment or an opportunity to resit your exams at a later date. The decision will be at the discretion of the EC Panel only.

The Extenuating Circumstances Panel needs to judge whether your circumstances were:

- Unforeseen
- Outside your control
- Were likely, on balance, to have had a direct and substantial impact on your ability to complete an assignment or sit an exam.

Examples of acceptable Extenuating Circumstances:

- Serious short term illness
- Bereavement
- Adverse personal or family circumstances
- Worsening of a long term health condition
- Serious personal injury
- Being the victim of a serious crime

NOTE: The information provided in this form will be kept confidential, for the sole use of decision making by the Al-Salam Insitute EC Panel.

1. Student Details

First Name *

Surname *

Email *

Student ID *

e.g. ASI151000

Level of Study *

2. Assessment Details

Module Title(s) *

The Module for which you completing the EC form (e.g. Arabic, Usul al-Fiqh, Hadith). Seperate multiple modules using a comma (,).

Assessment Type *

(Please check all that apply)

Examination

Assignment / Written Essay

Other:

Required

Submission Deadline / Assessment Date *

The date at which the assignment was originally due in or the original exam date.

YYYY

3. Statement about my extenuating circumstances

In your ‘Statement about my extenuating circumstances’ you should cover:

- What your extenuating circumstances are including the relevant dates.
- How the extenuating circumstances affected your performance or prevented you from attending or submitting work on time.
- Why the circumstances are unforeseen and outside your control.
- The steps you took to address the extenuating circumstances at the time (e.g. seeing a doctor/ counsellor, seeking support through relevant agencies).

NOTE : A longer statement does not increase the chances of your case being accepted and may make it difficult for the reviewers to identify the key elements in your case. Please keep your statement within 250 words.

Statement *

4. Declaration

Please confirm both of the following statements: *

I confirm that the information I have given is true and accurate to the best of my knowledge

I confirm that I have read and agreed to the 'Guidance and Criteria' section of this form.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms