School of Dental Sciences Personal Extenuating Circumstances Form

Before completing this form please refer to the PEC guidance available on Canvas in the Student Support and Progression section. Please note that we now require evidence to support your PEC application (unless it is a self-certification of illness in support of a request for an up to 7 day deadline extension for an in-course assessment).

We strongly advise speaking to your tutor prior to submitting this form

Full Name * First Last
Student Number *
Programme *
Stage *
Date of Birth * / DD / MM YYYY
University Email *
PEC Reason *
Name of tutor *
I have contacted my tutor before completing this form. In the case of a request for deferral, I have been made fully aware of the implications of my request, should it be granted. If you feel you are a long way short of the required level then the option to re-sit the year should be considered.
Adjustment requested. *
Other (please give details)
Further details about your requested adjustment:
Provide details of the adjustment required e.g. the assessment concerned, the original deadline or date of assessment, the length of an extension requested. Please indicate where you have previously been granted an extension or adjustment. If you are asking for adjustments to different assessments, provide detail of the adjustment requested for each: *
If you are requesting an extension please advise what date you will be able to submit: / DD / MM YYYY
Details of Personal Extenuating Circumstances:
Please provide as full explanation of the personal extenuating circumstances as possible. Please be specific about the problem, be precise about how your studies and/or assessment have been affected and explain any delays in submitting this PEC form. *
Evidence
Please note that we now require evidence in support of your PEC application (unless it is a self-certification of illness in support of a request for an up to 7 day deadline extension for an in-course assessment). For examples of acceptable evidence consult the School’s PEC Policy document on Canvas and seek guidance from your tutor.

Please attach this to your application below.
Evidence

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Evidence

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Evidence

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Evidence

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Evidence

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Student Support Plan
Please tick if you have an SSP
Data Protection Statement

Any personal data will be treated confidentially and will only be made available to the PEC Committee and the necessary administrative staff so that a decision on your PEC application can be reached. Personal data will be retained for 2 years after you graduate.

School of Dental Sciences Personal Extenuating Circumstances Form

School of Dental Sciences Personal Extenuating Circumstances Form

Data Protection Statement