Professional Documents
Culture Documents
Name:
Student ID No:
Course:
Intake:
Email Address:
I confirm that to the best of my knowledge the information given on this form is a true and accurate statement of my personal circumstances. I understand that details of this claim will remain confidential to the panel except in certain circumstances detailed in the procedures.
PART C: DETAILS OF CIRCUMSTA CES Please give brief details of your circumstances do not exceed the space provided.
Position:
Telephone No:
Signature:
If the circumstance covers more than one module/course component, part C need only be completed once. Please provide a brief outline of the extent to which, in your professional judgement, the student was/will be affected by the circumstances and the dates to which his/her circumstances apply.
Supporting Statement
EC_Req
All the boxes in the table completed All your personal details completed fully The circumstances affecting your work are fully explained
Supporting Evidence Relevant supporting Evidence attached and/or Part D Completed fully
Latest Drafts of work attached as proof of work completed (if required) ___________________________________________________________________________________ PART F: FLOWCHART OF PROCEDURES Collect Form
Hand in form to UCTI Administration including latest drafts of work as proof of the work youve done (if appropriate)
Obtain acknowledgement receipt The Panel meets once each month and your claim will be considered at the next meeting following your submission of this Form
Panels decision notified to you. Appeal UPHELD Decide to accept grade awarded or submit for further assessment Appeal NOT UPHELD Appeal against the decision by writing to Operations Manager within 7 working days of receipt of Panels decision. For modules at level 2 and 3 it will then be sent to Staffordshire University for consideration
EC_Req
__________________________________________________________________________________________
EC_Req