Kensington College of Business

Mitigating Circumstances Claim Form

Please read the notes for guidance when completing this form as Incomplete claims will not be accepted
Please PRINT clearly

Section 1 - Your details:

Name: Contact Address: E-mail Address: Telephone: Landline Telephone: Mobile KCB ID No. Post Code: Course : Intake: Wales USN No. Signature:

Section 2 - Your explanation of circumstances affecting your performance:

Time period covered by circumstances

Section 3
Module Code

Which modules have been affected? You MUST complete all details in this section
Assessment type Module Title Exam / Coursework Date Coursework / Exam due Indicate what you are applying for NonPoor Submission Late Submission performance (tick) (date submitted) (tick) Name of Tutor

Independent evidence (e.g. medical certificate)

attached

to follow

I confirm that the information given by me on this form is to the best of my knowledge accurate and complete. Students signature: Received by (office use only): Date: Date:

DATA PROTECTION: Kensington College of Business will process the personal details collected on this form strictly within the limits of the Data Protection Act 1988 and in accordance with the principles set out in the Colleges Data Protection Statement. OUTCOME - Decision of the Mitigating Circumstances Panel Claim approved

Claim Declined

Claim Deferred

Date of decision

Note: Chairs Signature : Date:

APPLICATION FOR MITIGATING CIRCUMSTANCES NOTES FOR GUIDANCE Students must ensure they refer directly to the notes for guidance when completing an application for mitigating circumstances. Incomplete forms will be rejected. Section 1 Please ensure this section is completed in full. (You will find your Student ID Number on your enrolment card). Section 2 It is essential that you provide a clear summary of the reason for your mitigating circumstances. Example 1: I was sick for a few days. This is not acceptable and will be rejected. Additional detail and independent supporting evidence required. Example 2: I was suffering from a viral infection from January 1st to January 6th inclusive supporting evidence from my GP is enclosed. This is sufficient. Section 3 It is essential that the full module title be inserted onto the form to ensure any mitigating circumstances that are accepted are applied to the correct module/s. If you do not know the correct details please ensure that you contact the where a member of staff will be able to provide you with these details. Mitigating Circumstances should be applied for the following situations: Non submission No could coursework submitted and / or examination sat. Poor performance this should be due to illness, personal or social reasons and not due to poor time management. for those students who have valid reasons for missing the submission deadline you should submit your assignment/dissertation at the earliest opportunity. You must however complete and submit a mitigating circumstances form (to be accompanied by appropriate evidence), indicating the valid reasons for the delay in submission. If you are applying in these circumstances, please ensure that late submission is clearly indicated in the box in section 2. The committee will only consider prolonged periods of illness, special circumstances etc. as mitigating circumstances with regards to the submission of dissertations, unless the period concerned is immediately prior to the submission deadline. Short periods of illness during the dissertation period are not regarded as mitigating circumstances.

Late submission

Dissertations

Section 4 You are reminded that it is your responsibility to provide appropriate evidence to support any claim for mitigating circumstances, failure to submit this evidence prior to the advertised deadline will result in your claim being rejected. Examples of acceptable evidence include: Death Certificates, Medical Certificates or GP letters, Legal Notices. Applications will ONLY be processed with your signature and Registrars signature. Due to this and the need for supporting evidence electronic applications will not be accepted. It is the responsibility of the student to ensure correctly completed applications are submitted prior to the deadline, which is clearly defined with section 1 of the application form.