Motivation Form
Participant name:
Student ID No.:
Type of (Master) Program:
Intake (Group) No.:
MSM or Partner Institution name:
MBA Program location
(City & Country):
MBA /
EMBA /
IMBA /
MSc /
EP /
MBM
Motivation with regard to:
Examination / Assignment / Master Thesis / BHAP grades and grading process
Dismissal from program and request to re-enter the program
Due to insufficient academic performance (e.g. more resits than allowed)
Due to lack of academic progress (e.g. participant does not fulfill the degree requirements
within the program duration or within five (5) academic years)
Due to failure of the performance segment (Master Thesis)
Academic Misconduct (i.e. plagiarism, exam fraud, forgery and academic outsourcing)
Request for exemptions (waivers)
Receiving a certificate or degree
Extension / Deferral of:
Master study
Coursework
Master Thesis
Other, please specify: ………………………………………………………………………….
Attachments:
Examination script
Assignment script
Examination questions
Assignment description
Examination model answers
Mark objection form
Case(s) used during examination/assignment
Overall grade transcript
Master Thesis
Ephorus report
Thesis evaluation form
BHAP
Reporting academic misconduct form
Verification documents e.g. doctor’s certificate for personal distress
Other, namely: …………………………………………………………………………………
Motivation for personal distress (If applicable)
(Reasons beyond the control of the participant, such as health issues, deceased family etc.)
Please submit this form plus attachments (if any) to the MSM Examination Board
(ExaminationBoard@msm.nl)
Date: 14-07-2014, approved / Document owner: Secretary MSM Examination Board
Motivated reaction/ request
(Please clearly motivate and be as precise as possible)
Declaration:
- I have read the Participant Handbook, which contains information on MSM, core values, the Participant
Code of Conduct, and the Education & Examination Regulations (EER) applying to the MBA/MSc/MBM
program or the program booklet applying to the EP programs.
- I understand and accept these policies and regulations.
Date (dd/mm/yy):
Signature participant:
Please submit this form plus attachments (if any) to the MSM Examination Board
(ExaminationBoard@msm.nl)
Date: 14-07-2014, approved / Document owner: Secretary MSM Examination Board