Form 1

Assignment/Practice Extension Form

Please complete a separate form for each element of the module or practice placement. When completed
submit to the member of staff authorised to approve the extension in the Faculty together with all supporting
documentary evidence (please refer to your School Administrative Office for details of authorised signatories).
When completing this form you are advised to consult Mitigating Circumstances (2012) which details the
regulations relating to the procedure for submitting a request for an extension and to seek advice from the
School Registrar, Students Union Advice Centre or Disability Support Service. Contact details for SU and FAQs
can be found on the next page.
Student Name:

Student ID:

Course of Study:

Year:

Module/Assessment or Placement Details

Module code:
Module/ Placement title:
(e.g. Research Methods or Placement 1)

Assessment task:
(exam, coursework, presentation etc)

Title of Assessment or Practice Document

Assessment or Placement Documentation
due date:

Reason for the request

(please give an overview of the reasons further detail can be appended on a separate sheet if necessary)

Documentary evidence
(it is the responsibility of the student to ensure that all documentation to support the request is attached to this form. Any highly
sensitive evidence may be provided in a clearly labelled, sealed envelope)

Description of evidence

Period covered
From

Student signature:

To

Date:

For office use only

Authorised tutor decision
(please circle):

Signature of authorised
member of staff:

Mitigating Circumstances Policy (2012)

Accepted

New Date for

Submission:

Rejected

Reason for rejection:

Date:

Form 1

Form 1
When filling in the form please ensure that you have completed it in full, please pay particular attention to:

Details of Assessment
Provide fill the details in as fully as possible, in order that the authorised member of staff has the correct
information on which to base their decision.

Reason for the extension request

Give details of the reason for your claim. You should ensure that they provide a full account of the
circumstances claimed, with sufficient detail of dates and times. Where necessary you can provide additional
information on a separate sheet and append it to the form.

Documentary evidence supplied

Give details of each piece of documentary evidence submitted, together with the time period to which it relates.
Evidence of a sensitive and personal nature can be submitted in a confidential envelope for consideration by the
Authorised member of staff. This will not be divulged to a third party. Please see the mitigating circumstances
policy for further information.

Support and Guidance

You are encouraged to contact your tutor, school registry team and other university support teams. Independent
support and advice can be sourced from the Students' Union Advice Centre either at High Wycombe or
Uxbridge Campus. For more information about services and opening times, check out
bucksstudent.com/advice, email SUAdvice@bucks.ac.uk or call on 01494 603 016.
High Wycombe Campus
(North Wing, ground floor)
Monday - Thursday 9.30am- 7pm
Friday 9am - 4pm

Mitigating Circumstances Policy (2012)

Uxbridge Campus
Monday 10am - 6pm
Tuesday and Thursday 9.30am - 5pm
Wednesday 9.30am - 5pm
Friday 9.30am - 3.30pm

Form 1

FAQs
1. What would be considered grounds for an extension?
The University recognises that sometimes, something happens that is beyond the ordinary stresses of life and
seeks to offer the opportunity for students to achieve what would be considered their normal standard of
academic work.
2. What is normally considered to be outside the ordinary stresses?
Examples of circumstances which might normally constitute grounds:

Illness during the lead up to assessment hand in or during placements

Death of a family member or close friend
Severe unforeseen personal or psychological problems
Flare-up or exacerbation of a chronic condition
Complication of an existing condition or additional impact of a disability

3.
What is not normally considered?
Indicative examples of circumstances which will not normally be considered as grounds include:

Paid employment, although exceptions may be made where an employer makes additional and
unforeseen demands on an employee e.g. sending an employee overseas at short notice
Misunderstanding of the University procedures e.g. not knowing an assessment date
Computer or printing problems
Holiday

4. If my extension is granted, how do I submit the assignment/ practice documentation

The member of staff authorised to grant extensions will explain the faculty procedure for the submission of the
assignment/practice that has been granted the extension.
5.
How long will the extension be for?
The length of time granted for an extension will normally reflect the amount of time lost because of the event in
respect of which you have claimed. The deadline for an extension will normally fall before the date for feedback
to the cohort and the relevant Board of Examiners.
6.
If I have an extension granted can I submit a plea for Mitigating Circumstances?
Where an extension has been granted, you will only be able to enter a plea of mitigation in respect of this
assignment/practice document if you experience a different unpredictable or unforeseen event during the period
of the extension or a sudden deterioration or unexpected continuation of a previously notified condition.