PEC Form CASE B
Student notice of
Personal Extenuating Circumstances
To be completed by Undergraduate or Taught Postgraduate
Students
Students who believe that their performance in or ability to complete assessments is being significantly
affected by personal extenuating circumstances should advise the examiners by completing this form, so that
the appropriate adjustments can be made. Forms must be submitted to the School Office as soon as a
problem arises. The PEC procedure and advice on completing the form is available at
www.ncl.ac.uk/students/progress/student-resources/help/ - YOU SHOULD READ THE GUIDANCE.
STUDENT DETAILS:
Name of Student:
STUDENT CASE B
Name of Personal Tutor:
Dr AN Other A
Programme:
XXXXXXXXXXXXX
University email address:
B.xxxx @ncl.ac.uk
Student Number:
XXXXXXXXX
Stage:
Full Time
1
Part Time
Is this form being submitted to update, supplement or provide new evidence
for a previously submitted PEC form?
Yes

No



MODULE / ASSESSMENT DETAILS:
Module Code
(e.g.
COM1001):
Module 1
Module 2
Module 3
Module 4
Module 5
Aspect Affected
(e.g. Essay, Exam, Attendance):
Module Leader:
Dates of exam/ submission
etc:
Exam
Exam
Exam
Exam
Exam
Dr AN Other B
Dr AN Other C
Dr AN Other D
Dr AN Other E
Dr AN Other F
17/1/XX
13/1/XX
12/1/XX
19/1/XX
22/1/XX
HOW ARE YOUR STUDIES AND ASSESSMENTS BEING AFFECTED? (tick all that apply)
Because of the circumstances described below, I am:
Unable to submit my work on time;
Unable to submit my work, despite being given an extension;
Unable to participate in group work;
Unable to attend University for more than five days;
Unable to attend my exam(s) or other assessed session(s);
Unable to write comfortably in examination conditions;
Unable to prepare effectively for my examinations;
Able to work, but feel my performance has been affected;
Affected in the following way, not listed above:
Details:









Continue on separate sheet if necessary
PROPOSED ADJUSTMENT: (Please tick one– but note the PEC Committee makes the
final decision about the most appropriate form of adjustment)
Extension
 Deferral of assessment attempt to next

Repeat Stage or Semester as first attempt

normal occasion of assessment
Be considered for Board of Examiners
discretion
(this will normally only occur if a more
practical adjustment cannot be given)


Other adjustment (please detail)
FURTHER DETAILS:
Provide details of the adjustment requested 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 applying for multiple modules or assessment , provide detail of the adjustment requested for each:
Details:
Continue on separate sheet if necessary
DETAILS OF PERSONAL EXTENUATING CIRCUMSTANCES: (please tick)
Medical
 Personal
 Other

Period affected: From.......October 20XX ..........................(Date) To.............Ongoing.............................(Date)
Please provide as full an 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.
Details:
Severe depression due to addiction to gambling and drug abuse has affected my revision. I am currently
undergoing counselling through the Student Wellbeing Service and on a course of anti-depressants
prescribed by a GP. It has become more severe since the start of January 20XX.
Continue on separate sheet if necessary
EVIDENCE: (please tick and ensure that the evidence is submitted with your
application. Note that applications submitted without any evidence will be unlikely to
be successful)
Medical Note
 Wellbeing Memo
 Other

Note from GP
Letter from Student Wellbeing Service
Signature (student):
..................XXXXXXX............................................
Date:
Have you consulted your personal
tutor?
Yes

No

1/6/XX
Your personal tutor or other member of staff may be asked to provide further information about your case.
If you are not happy for this consultation to take place, please tick here and provide an explanation

_____________________________________________________________________________________
Brief guidance notes to students:
 Do not submit PEC forms for minor issues that have not affected your studies.
 Make sure that you are aware of and understand any School rules about PEC (for
example, whether there is a deadline, whether it is not possible to seek
extensions for certain modules etc.).
 Do not assume that you will be given an extension, deferral or other adjustment.
Until you are informed of the PEC Committee decision, you need to continue with
your studies as normal.
 Ensure that every section of the PEC form has been completed.
 Ensure that any additional sheets or documents are clearly marked with your
name and student number.
 You will be informed of the outcome by email so make sure that you check your
University account regularly.

More detailed advice to students on completing the PEC form is available at
www.ncl.ac.uk/students/progress/student-resources/help/
23rd January 20XX
TO WHOM IT MAY CONCERN
RE: Student B
This letter is in support of a PEC application which will be submitted by the
above named student. I have been meeting and keeping in touch with
student B since the 6th of January 20XX in my role as a Wellbeing Adviser
(Mental Health).
Student B has always accessed the support that has been available to him to
help with his mental health difficulties. Over recent months he has had to
cope with difficulties surrounding gambling and substance misuse, which have
affected him greatly and this in turn has affected his ability to focus on his
University Studies effectively.
He has experienced stress related conditions, insomnia, low mood and poor
concentration due to this. And as a consequence this will have had a
detrimental affect on his ability and motivation to revise and complete his
coursework. Some days student B is able to manage the impact more
effectively, however, overall this has reduced his performance.
Please consider these factors when you are discussing student B’s University
work. Should you wish to discuss this further with me then please do not
hesitate to contact me on 222XXXX or via email XXXXXX@ncl.ac.uk.
Kind regards
XXX
Student Wellbeing Adviser (Mental Health)
Student Wellbeing Service
Medical Group
17 Osborne Road, Jesmond,
Newcastle upon Tyne. NE2 2AH
02.02.20XX
To Whom It May Concern:
Student B
This young man has been under our care having been seen by one
of my partners on the 6th January and myself today the 30th
January. He has been treated with Fluoxetine for a depressive
illness, and although he is improving I think it is likely that it
might be some weeks before he feels fully fine I hope this
information can be taken into consideration.
Yours sincerely
Dr A R Moore