Heriot-Watt University
PART A:
Application for Consideration of Mitigating Circumstances (MC)
Request for medical and/or mitigating personal circumstances to be presented
to the Mitigating Circumstances Committee.
Instructions
PLEASE PRINT CLEARLY USING BLACK INK AND SIGN, OR EDIT USING MICROSOFT
WORD, PRINT AND SIGN.
This application for consideration of mitigating circumstances should be submitted in hard
copy, accompanied by the appropriate evidence (unless submitted previously), to the School
Office in the student’s home School as soon as possible and ideally within five working days
of the events under consideration for on-campus students, or as agreed by your home
School. All material must be submitted in a sealed envelope marked ‘Mitigating
Circumstances Private and confidential’.
You are advised to keep a copy of the completed form for your own records.
Your details
Name
Student Number
Email
Postal Address
Your programme
Degree programme
Place of study
Mentor
Year of study
Period covered by mitigating circumstances
From:
To:
Courses and Assessments Affected
Course Code
Course Title / Assessment Title
Dates
PART A: Application for Consideration of Mitigating Circumstances
Approved by Quality and Standards Committee (QSC), 7 September 2011
Revisions approved by QSC July 2014
1/3
Details of mitigating circumstances
Please provide a description of the mitigating circumstances that may have affected your
performance in the above courses or assessments. Please state what aspect/s of the courses
or assessments you feel have been affected.
Please use an additional sheet if necessary.
Documentary evidence
Please list all the documentation provided in support of your claim. The documentation should
be stapled to this form and submitted in a sealed enveloped marked ‘Mitigating
Circumstances, Private and confidential’.
Medical claims should be supported by a medical certificate; other claims should be
supported by appropriate documentation, e.g. police reports, death certificate. For further
guidance refer to the University’s Mitigating Circumstances Policy
(http://www.hw.ac.uk/committees/ltb/ltb-policies.htm) or to your programme/School
Handbook.
Any details of a confidential nature may be placed in a sealed enveloped marked ‘Confidential
for the Chair of the Mitigating Circumstances Committee’ and securely attached to this form,
which should be submitted to the School Office.
Your signature
I declare that the information contained in this statement is accurate and complete to the best
of my knowledge. I consent to the information being used by the Mitigating Circumstances
Committee and understand that the information will be treated in the strictest confidence.
Signed:
PART A: Application for Consideration of Mitigating Circumstances
Approved by Quality and Standards Committee (QSC), 7 September 2011
Revisions approved by QSC July 2014
Date:
2/3
PART B:
Outcome of Application for Consideration of Mitigating Circumstances
To the Student:
Your School will notify you via email if your application has been unsuccessful. Please note
that all email correspondence will be sent to your Heriot-Watt email address and will be
provided as soon as possible following the meeting of the Board of Examiners and publication
of exam results.
Note that decisions 3-6 below, and possibly also 7, indicate an unsuccessful application. For
further information regarding the decision, please contact your School Office.
To the Chair of the Mitigating Circumstances Committee:
As a minimum requirement, the recommendation marked on this form will be shared with the
student following the decision of the Board of Examiners in circumstances where the
application has been unsuccessful (decisions 3-6, possibly also 7).
Recommendation of the Mitigating Circumstances Committee (please circle one: 1-7)
1
The mitigating circumstances presented are sufficient, on the basis of the evidence
provided, to support a change in degree classification or a change in decision
regarding progression. Our recommendation is:
2
In the light of the candidate’s overall assessment profile, there are sufficient grounds
to conclude that the candidate’s performance in the relevant assessment/s had been
adversely affected, but not to such a degree as to materially affect the degree
class/award or the progression decision. Our recommendation is:
3
In the light of the candidate’s overall assessment profile, there are insufficient grounds
to conclude that the candidate’s performance in the relevant assessment/s would have
been significantly different in the absence of the mitigating circumstances presented.
4
The mitigating circumstances presented are of such a minor nature that they are
unlikely to have influenced the student’s performance in the relevant assessments.
5
No evidence is presented in support of this application.
6
The circumstances presented are not accepted as justification for special
consideration in accordance with the Mitigating Circumstances Policy:
http://www1.hw.ac.uk/committees/ltb/ltb-policies.htm#M
7
Other (please specify)
Signed:
(Chair of the Mitigating Circumstances Committee)
Date:
Name of School:
PART B: Application for Consideration of Mitigating Circumstances
Approved by Quality and Standards Committee (QSC), 7 September 2011
Revisions approved by QSC, July 2014
3/3