7/27/2019 Mitigating Form

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SchoolofCultures,LanguagesandAreaStudiesApplicationforconsiderationofmitigatingcircumstances

N.B.ThisformisforuseONLYbystudentsondegreeprogrammesownedbySOCLAS.Otherstudents must submit their claim to their home Department/School, even if they areclaiminginrespectofmodulestaughtbySOCLAS.Before completing this form, please read the University's guidance note on mitigatingcircumstances:http://www.liv.ac.uk/tqsd/pol_strat_cop/mit_circ_pol_final_Nov04.docFullname:

Registrationnumber: ..

Programmeofstudy: ..

Yearofstudy: Semester: .Personaltutor: ..

Modulesaffectedbymitigatingcircumstances(completeaseparatelineforeachassessment)

Modulecode ModuleTitle Tickbeneathtypeofassessment(s)affected

Exam Classtest C/wk

Tickifassessmentmissed

Tickifassessmentaffected

Dateofexamorassessment

7/27/2019 Mitigating Form

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DetailsofmitigatingcircumstancesPleaseprovideadescriptionofthemitigatingcircumstancesthatyoubelievemayhaveaffectedyourperformanceintheabovemodules,includingthetimeperiodoverwhichthesecircumstancesoccurred.Pleasestatewhataspect(s)oftheassessmentyoufeelhavebeenaffected.Continueonaseparate

sheet

if

necessary.

Be

prepared

to

supply

additional

information

swiftly,

if

asked

to

do

so.

SupportingdocumentationPleaselisthereallthedocumentationattachedtoyourclaim.Medicalclaimsmustbesupportedbymedicalevidence;otherclaimsshouldbesupportedbyappropriateevidence(forexample,policereports,insurancereports,copiesofappropriatecertificates).

ThisformandanydocumentaryevidencemustbesubmittedtotheSOCLASoffice,room222,onthesecondflooroftheModernLanguagesBuilding.PleasemarkitfortheattentionoftheSOCLASAssessmentDirector.YouwillbenotifiedoftheoutcomeofyourclaiminwritingaftertheappropriateMitigatingCircumstancesCommitteehasmet.StudentdeclarationIconfirmthatalltheinformationcontainedinthisstatementisaccurateandcompletetothebestofmyknowledge.IconsenttotheinformationbeingusedbytheMitigatingCircumstancesCommittee,andunderstandthattheinformationwillbetreatedinthestrictestconfidence.Signatureofstudent:.. Date:..