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retrieveStudentForm 1

The document appears to be a deferment form for a student seeking to defer submission of assignments, attendance at exams or lectures, with sections for the student to provide their details, state the modules and type of deferment requested, and reasons for deferment, and for staff to comment and approve or deny the request.

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shapscribdo
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© Attribution Non-Commercial (BY-NC)
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Download as PDF, TXT or read online on Scribd
14 views

retrieveStudentForm 1

The document appears to be a deferment form for a student seeking to defer submission of assignments, attendance at exams or lectures, with sections for the student to provide their details, state the modules and type of deferment requested, and reasons for deferment, and for staff to comment and approve or deny the request.

Uploaded by

shapscribdo
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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Admin Counter Used Only:

Received By: ___________ Acknowledgment Student ID No.: ___________


Received On : ___________ of receipt of
Received On : _____________
Deferment Form
Acknowledged By : _________

Deferment Form
SECTION 1 - TO BE COMPLETED BY STUDENT
Note: Applicant must complete all relevant sections in full

Name:

Student Registration Intake


Number: Code:
Correspondence
Address:

Telephone Number: Home - Work -

Email Address:

I wish to defer the following (please tick more than one if appropriate):

Submission of an assignment, project or other coursework. Please specify modules below, code A

Attendance at an examination or test. Please specify modules below, code B

Attendance at lectures/tutorials for a module. Please specify modules below, code C

In the following section list the modules affected and show the type of deferment as identified above
(I.e. code A, B or C)
Enter code A,
Module Title & Code Effective date of deferment Proposed date of continuation B or C from
above

Please provide brief details of your reasons for deferment, and enclose the necessary supporting document (if any).

I confirm that the information given on this form is a true and accurate statement of my personal
circumstances. I understand that details of this application will normally remain confidential.

Signature: Date:

Issue 1.0 July 2004 Defer_Form


SECTION 2 – TO BE COMPLETED BY STAFF MEMBER (S)

Name: Position:

Signature: Date:

Supporting statement:

SECTION 3 – APPROVAL

Tick the appropriate box:

APPROVED

NOT APPROVED

SUBMIT TO EC BOARD

Recommendations/Comment/Conditions:

Programme Leader: Signature: Date:

Issue 1.0 July 2004 Defer_Form

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