ࡱ; B A !"#$%&'()*+,-./0123456789:;<=>?@CRoot Entry   FMicrosoft Word-Dokument MSWordDocWord.Document.89qDyK  yK Xhttp://www.qmu.ac.uk/quality/gr/default.htmpolDyK yK: [jjDefaultd1$A$*$/B*OJQJCJsH sH PJ^JaJ_HtHnHnn Heading 1!@& & F & F$$'B* ph6_OJQJCJ5PJ^JaJ\`` Heading 5!@& & F & F$$B* ph$?`OJQJPJ^Jjj Heading 7.@& & F & Fd7$5$9D$OJQJ5PJ^JaJ"" WW8Num1z0&& WW8Num2z0o("" WW8Num2z1"!" WW8Num2z2"1" WW8Num2z3"A" WW8Num2z4"Q" WW8Num2z5"a" WW8Num2z6"q" WW8Num2z7"" WW8Num2z822 WW8Num3z0OJQJ^Jo(22 WW8Num3z1OJQJ^Jo(22 WW8Num3z2OJQJ^Jo(66 WW8NumSt1z0OJQJ^Jo(<<Default Paragraph FontDDHeading 7 CharOJQJ5PJ^JaJ>> Header CharOJQJCJPJ^JaJDDBody Text CharOJQJ6PJ^JaJTTHeading 1 Char'B* ph6_OJQJCJ5PJ^JaJ\F!FHeading 5 CharB* ph$?`OJQJPJ^J6U16 Internet Link B*ph>*:A:Comment ReferenceCJaJ:Q:Comment Text CharCJaJFaFComment Subject CharCJ5aJ\FqFBalloon Text CharOJQJCJ^JaJ&& Footer CharFVFVisited Internet Link B* ph>*FFHeading *x$OJ QJ CJPJ ^J aJ\B\ Text body +d$a$7$5$9DOJQJ6PJ^JaJ/List,<<Caption -xx $CJ6aJ]""Index. $PPHeader/d7$5$9DOJQJCJPJ^JaJnn Body Text 22,0d$a$7$5$9D^h]`OJQJCJPJ^JaJnn Body Text 21,1d$a$7$5$9D^h]`OJQJCJPJ^JaJ:": Comment Text2dCJaJ8!"8Comment Subject35\NBN Balloon Text4dOJQJCJ^JaJ<R<List Paragraph5^]`. b.Footer6dhrh WW-Default 71$7$*$5B*phOJQJCJsH sH PJ^JaJ_HtHnH44Table Contents8 $>> Table Heading 9$a$ $5\ `>@JLNPDB,! XhhH !!! !"#$%&'()*+,-./V5 a x XX^`P^@`@^`0^```^`^`^`^``^0`0@  P GTimes New Roman5Symbol3&ArialGTimes New Roman7&Calibri7Cambria?4Courier New;Wingdings5&Tahoma3&ArialIArial Unicode MSBh.k.k 88 88'00nkettkbrowne <mailto:SCHOOLOFFICE@QMU.AC.UKOh+'0 X` Extenuating Circumstances formnkett A8220970kbrowne2@F#@@@՜.+,D՜.+,M 0!Caolan80 :` O  8$ $H K$ ((bKB6L  * You should read the HYPERLINK "http://www.qmu.ac.uk/quality/gr/default.htm" \l "pol" Guidelines on Extenuating Circumstances Who can give advice on whether to submit Extenuating Circumstances? You are advised to contact your Personal Academic Tutor or the Welfare and Representation Coordinator based in the Students Union. Confidentiality Please note that the information that you provide on this form will be made available to your Programme Leader and may need to be discussed with other staff on a strictly need to know basis e.g. your Personal Academic Tutor and/or the Convener of the Board of Examiners. If your circumstances are of an exceptionally delicate or personal nature and you do not wish to document them in detail, you are advised to contact your Personal Academic Tutor for advice. If you have been receiving counselling support, you may also contact the Student Counsellor who will provide confirmation to your Programme Leader that you have sought advice and support from that service (no further details will be divulged without your consent). PART A  TO BE COMPLETED BY THE STUDENT Name:Matriculation number:Programme of study:Year of study:Contact phone number: Please note that any email correspondence will be sent to your QMU student email account. Period(s) of time to which the circumstances apply and your assessment of the effect of the circumstances on your performance or ability to submit courseworkDates affected (DD/MM/YY to DD/MM/YY)Module codeModule titleComponent(s) affected (e.g. essay, exam, etc.)Original Submission Date  Reason for Request & Outcome Sought (e.g. extension (specify days), examination as first attempt in August, etc.):   The following supporting evidence is attached/to follow:1.Attached / to follow2.Attached / to follow Please note: Supporting evidence must be submitted as soon as possible and no later than one week after submission of the form. Do you have an Individual Learning Plan (ILP)?YES / NO CHECKLIST AND STUDENT DECLARATION In confirm that I have:Fully completed all sections of the formYES/NOAttached supporting evidence or indicated where it is to followYES/NOI certify that the information I have given on this form is correct to the best of my knowledge. I give my consent for the persons named on this form to have access to the information provided, strictly on a need to know basis and solely in connection with the processing of my claim for extenuating circumstances. Signed:  Date: COMPLETED FORMS SHOULD BE EMAILED TO  HYPERLINK "mailto:SCHOOLOFFICE@QMU.AC.UK"SCHOOLOFFICE@QMU.AC.UK OR YOUR PROGRAMME LEADER PART B  TO BE COMPLETED BY QMU STAFF (AS APPROPRIATE) Extension Request UPHELD / NOTUPHELD (please circle) Module codeModule titleComponent(s) affected (e.g. essay, exam, etc.)New Submission Date  Signature of Programme Leader:................................................. Date: ...................... Name of Programme Leader: & & & & & & & & & & & & & & & & & & & & & & & & & & ..  Programme Leader/Personal Academic Tutor comments (if appropriate):   Signed:  Date: QUEEN MARGARET UNIVERSITY EXTENUATING CIRCUMSTANCES FORM Dec 2015 &(    ptxz 48:VZ\@DĿyyyyyyymmCJ6^JaJOJQJCJ5^JaJOJQJCJ6fHq ^J CJ6^JCJ^JaJOJQJCJ>*^JaJOJQJCJ>*5^JaJOJQJCJ^J^J >*5^J7CJ65^J0J#B*phCJ6>*^J0J#CJ65^JjUUCJ65^J*D~*\26:>fjnrZ^p~B CJ6^JCJ65^JaJOJQJCJ6>*5^JaJOJQJCJ^JaJOJQJCJ5^JaJOJQJMB  jl$(  :f,󿬘!B*phCJnH ^JaJOJQJ'B*phCJ5nH ^JaJ\OJQJ$B*phCJnH ^JaJ\OJQJ!B*phCJnH ^JaJOJQJ0J#CJ5^JaJOJQJjUUCJ^JaJOJQJCJ5^JaJOJQJ3,F J L !! !!!!!!!!!!!6 ^JOJQJ5^JOJQJCJ^JaJOJQJCJ5^JaJOJQJ!B*phCJnH ^JaJOJQJ-B*phCJ65nH ^JaJ]\OJQJ!   ||dd$d%d&d'd+$a$ddd/ 0$a$^]` 0$a$^]` 0$a$^]`+$a$$d%d&d'd+$a$$d%d&d'd   $IfdG$P$$If0 # p44l44l4f4$IfdG$ $Ifd 68:XAP$$If0 # p44l44l4f4$IfdG$ $IfdP$$If0 # p44l44l4f4XZ\2P$$If0 # p44l44l4f4$IfdG$ $IfdP$$If0 # p44l44l4f4$IfdG$BD,^:$$If#  p 44l44l4f4 $Ifdddd l]N?0$IfdG$$IfdG$$IfdG$$IfdG$$$Ifr 7p# 2p244l44l4f4]N?0$IfdG$$IfdG$$IfdG$$$Ifr 7p# 2p244l44l4f4$IfdG$N?0$IfdG$$IfdG$$$Ifr 7p# 2p244l44l4f4$IfdG$$IfdG$?0$IfdG$$$Ifr 7p# 2p244l44l4f4$IfdG$$IfdG$$IfdG$0$$Ifr 7p# 2p244l44l4f4$IfdG$$IfdG$$IfdG$$IfdG$d:$$If#  p 44l44l4f4$IfdG$:$$If#  p 44l44l4f4 $Ifdd 46<>h$IfdG$:$$If#  p 44l44l4f4 $Ifddhjpr|$IfdG$ $Ifdf$$IfF2# p44l44l4f4}p`$Ifd$a$ $Ifddddf$$IfF2# p44l44l4f4\^{@{:$$If#  p 44l44l4f4$Ifd$a$dd$d%d&d'd+$a$P$$If0# p44l44l4f4r=P$$If0p# p44l44l4f4$Ifd$a$P$$If0p# p44l44l4f4$Ifd$a$D $Ifd$a$G$$Ifd$a$$Ifd$a$G$:$$If#  p 44l44l4f4 $Ifd &( "<h~tttggg $Ifd d7$d$d%d&d'ddddP$$If0t# p44l44l4f4 hufWH$IfdG$$IfdG$$IfdG$|$$If\ u# (p(44l44l4f4 $IfdsdUF7$IfdG$$IfdG$$IfdG$$IfdG$|$$If\ u# (p(44l44l4f4$IfdG$sdUF$IfdG$$IfdG$$IfdG$$IfdG$|$$If\ u# (p(44l44l4f4sdUF$IfdG$$IfdG$$IfdG$$IfdG$|$$If\ u# (p(44l44l4f4H xxxi$Ifd7$ d7$|$$If\ u# (p(44l44l4f4H J L qb$IfdG$:$$If#  p 44l44l4f4 $Ifdd<$$If#b  p 44l44l4f4 !!!$Ifd$a$G$$Ifd$a$$Ifd$a$G$:$$If#  p 44l44l4f4 $Ifd!!!!!!!!!!!!!~|zxvq6$a$/dd ddP$$If0t# p44l44l4f4 !!!!!!!! 8. 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