EXTENUATING CIRCUMSTANCES
Any circumstances likely to affect your examination performance should be notified in writing, with
appropriate supporting documentation, and submitted no later than one week after the end of the
examination period in question. These circumstances will be considered in strict confidence.
Circumstances which have already been brought to the attention of the Board of Examiners and for which
allowance has already been made (eg extra time allowed because of dyslexia, extension of deadline for
coursework) should not be notified in this way. The examiners will be aware of these circumstances, but
any circumstances which might affect your examination performance can be taken into account only once
for each diet of examinations.
Please complete the form below and submit to Tony Roth. You should retain a copy of all documentation.
Section 1
NAME__________________________________________________YEAR__________________
DEPARTMENT___RESEARCH DEPARTMENT OF CLINICAL, EDUCATION AND HEALTH
PSYCHOLOGY_______
CONTACT (phone/email)___________________________________________________
COURSE TO WHICH EXTENUATING CIRCUMSTANCES APPLY: DOCTORATE IN CLINICAL
PSYCHOLOGY – WRITTEN EXAMINATIONS
Section 2 (a)
MEDICAL CIRCUMSTANCES
(To be completed by a medical practitioner or accompanied by medical certification. Continue on blank sheet provided if necessary)
Give the nature and severity of the student’s medical condition and describe any consequences of the
illness and/or treatment that may be relevant. Please provide the dates when the illness started and when
the student was/will be fit to return to study.
Signature of Medical Practitioner ____________________________Date _______________
(if appropriate)
Medical Practitioner’s official Stamp :
NON-MEDICAL CIRCUMSTANCES
(To be completed by applicant. Continue on blank sheet provided if necessary)
Give a brief description of the circumstances, accompanied by supporting documentation. Give the
dates you were affected; an explanation of how the situation affected your study/exam performance; and
what you have done about it. Have you already had consideration / extensions? What consideration are
you requesting?
Signature of Student ____________________________________Date _______________