Please read the accompanying guidance notes carefully to assist you with the completion of
this application form. The application should be submitted as a hard copy, accompanied by
the appropriate evidence, to the School Office (or other specified office as described in the
School’s guidance or handbook) of your home School. All material must be submitted in a
sealed envelope marked ‘Mitigating Circumstances—Private and Confidential’. Overseas
students studying on distance learning programmes should contact the School Office about
possible alternative submission arrangements.
Details of the circumstances that have significantly affected your performance (see
guidance notes). Please provide details of the impact for each element listed above.
1
For programmes that are not modularised (e.g. the MBChB and BDS) write ‘not applicable’.
1
Initially delay in completing matriculation in September 2017. I had problems with login
and registration to the correct course. At that time, I had notified Dianne, and she helped
me to get matriculated, though I nearly lost four weeks of study.
During Nov & Dec, I was under high work load and my teaching commitment, though I am
at senior member of staff within faculty of Nautical studies. I had to travel abroad to
conduct an external exam at one our partner university- AMET University, India. I am
attaching the time-table of my teaching commitment and travel itinerary.
The period(s) of time that From: Sept 2017 To: First week of Oct
you were affected 2018
From: To:
Evidence provided in support of your application (see guidance notes). Note whether
attached or to follow.
1. Email conversation with Dianne Cantali
2.Travel Itenary
3.Teaching Time-table
I declare that, to the best of my knowledge, the information I have provided is correct and
complete, and consent to this information being used by the Mitigating Circumstances
Committee.2
2
If your circumstances are of an exceptionally delicate or personal nature and you do not wish to
document them in detail you should contact your Adviser of Studies for advice.
2
Appendix 1