Coursework Extension Form

If you have difficulty in completing this form please visit the Support Enquiry Zone (SEZ).

This form should be completed in full by students who wish to extend their coursework deadline on the grounds of
mitigating circumstances which they believe may have affected their ability to complete coursework by the submission date.
Evidence must be attached.

Please familiarise yourself with the mitigating circumstances policy and ensure you understand what mitigating
circumstances are before submitting this form.

PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS & ENSURE THAT YOU SIGN AND DATE THE FORM.

Surname Forename

Student ID Number E-mail address

(University account)
Programme of Study

Level of Study Academic Session

Please list all modules and tick the units of assessment to which this claim refers.

NOTE: Normally extensions are up to 7 days, but exceptionally 10 days can be granted by the Academic Curriculum
Manager.

Module Module Title Assessment Tutor Coursework( Other, Date of Agreed Extension
Code CW) Please State Assessment Date

Please describe below the nature of the difficulties and period affected.

Nature of Difficulty Dates Affected

Please detail the evidence / documentation you are submitting. Any evidence must be attached to this pro forma and
have your name and matriculation number written on it. Originals must be submitted. Consult the mitigating
circumstances policy for examples of acceptable forms of evidence.

Details of Evidence / Documentation submitted in support of request for an extension

Student Signature:____________________________________________ Date:_______________________________