Completing an Extenuating Circumstances Application

Modified on Thu, 27 Mar at 3:52 PM

When applying for Extenuating Circumstances with the University of South Wales, a part of their processes will include filling out an Extenuating Circumstances Claim Form. Please find some general guidance on how to fill out the form below.

If you have any queries regarding the form that you haven't found an answer two, please contact either the Advice Zone or our Student Records Team at records@learna.ac.uk.

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EXTENUATING CIRCUMSTANCES CLAIM FORM

This form and the regulations to which it applies are for students on courses accredited by the University of South Wales (USW). This includes Partner College and Franchise courses.

Completed Extenuating Circumstances Forms and supporting documents must be submitted to the Advice Zone via Advice Zone Online.

All correspondence regarding your claim, including the outcome, will be sent through Advice Zone Online. This can be accessed from the Advice Zone Online button on UniLife.

Section 1: Personal details

Please check that the details populated are correct.

Student ID Number:	Insert USW ID Number	Academic Session:	Insert Cohort (e.g., March 2025)	Year of Study or Cohort:	Insert whether you're on Year 1 or Year 2 of your programme, as applicable.
First Name:	Insert First Name
Surname:	Insert Surname
Location of Course:	Learna Ltd \| Diploma MSc
Course Title:	Insert as applicable.

Section 2 – Fit to sit

The University operates a Fit to Sit Policy whereby all students, in submitting or presenting themselves for assessments, in person, online or on site, are declaring that they are fit to sit the assessment. When a student signs the attendance slip, accesses the examination or online assessment, or indicates they are present on an attendance register, a student is declaring themselves fit to sit.

Students cannot subsequently claim that their performance in that assessment was affected by existing circumstances or illness other than where there are additional conditions or events that arise, for instance where a student is taken ill during an examination and cannot continue to sit for the exam, or where their judgement was impaired and they were unable to make a rational decision about being fit to sit. This would be a ‘withdrawal of fit to sit’

Are you applying for assessments that you submitted/sat on the original assessment deadline/date?

☐ No

☐ Yes - You will need to provide an explanation of the exceptional circumstances, which you feel, made you unable to make a rational and considered decision when you declared you were fit to sit. You will need to provide supporting evidence of the exceptional circumstances.

This refers to whether you had initially submitted something for the component(s) you're applying for, but are looking to apply for extenuating circumstances as they affected your work.

Section 3: Extenuating circumstances

Use this section to provide details of your extenuating circumstances (What happened? When? How did it affect your studies?). If you are claiming as a result of a disability or long-standing condition please detail how this is currently impacting on your studies.

Describe your extenuating circumstances - what happened to you?

Section 4: Supporting information

☐ I am able to provide evidence to support my claim (maximum extension 15 working days or non-submission/deferral to next assessment period) Tick this if you are applying for the 15 Working Day extension.

NB – You will not be required to supply evidence at the point of application. However, you may be asked to provide supporting evidence when your claim is being assessed or for sample auditing.

☐ I am self-certifying due to a short-term illness (maximum extension 5 working days or non-submission/deferral to next assessment period if you are claiming for an on the day assessment e.g. exam, presentation) Tick this if you are applying for the 5 Working Day Self-Certified Extension.

NB - The illness must have occurred no more than one week prior to, and/or including the week in which the assessment was due. If your circumstances are expected to last longer than 7 calendar days, you should submit independent supporting evidence and not use self-certification.

☐ I am a disabled student/I have a long-standing condition that is impacting on my ability to submit/sit assessments (maximum extension 15 working days or non-submission/deferral to next assessment period) Tick the applicable if you are applying for the 15 Working Day extension or a non-submission, due to long-standing conditions. DSA allowance would be considered our partner-college equivalent Individual Support Plan.

☐ I have an Individual Support Plan (or equivalent if studying at a partner college) that supports my claim

☐ I don’t have an Individual Support Plan (or equivalent if studying at a partner college) and am providing

evidence to support my claim

☐ I have previously provided evidence that supports my claim

Section 5: Late submission of extenuating circumstances

Only complete this section if you are making a late claim. A claim is considered to be late if it is submitted more than 5 working days after the assessment submission date.

You must provide a clear explanation for why you were unable to, or did not, submit a claim within 5 working days from the date of the assessment/s and this must be supported by independent evidence. Self-certification cannot be claimed if your claim is submitted under a late submission of extenuating circumstances.

Only fill this out if applicable, as detailed in the two paragraphs above.

Section 6: Modules affected

Please select whether you are requesting a deadline extension or non-submission/attendance for each affected assessment by placing an X next to the relevant checkbox

Extension: This means that you are requesting more time to complete your assessment. If you are applying for an extension you should aim to submit your work as soon as you are able and not wait for the outcome of your claim.

Non-submission/deferral: This means that you are requesting not to submit the assessment or exam/test until the next available opportunity. This may be in the re-sit period, or the next session for this module (this may be a new assessment title or exam). Please contact your module tutor for further information.

Enter the module tutors name for each affected assessment
Enter the original submission or exam date for each affected assessment
If you are requesting an extension enter the date you wish to submit the assessment

The extension requested will be dependent on how you are supporting your claim (see Section 4) and, if relevant, the information provided on your supporting evidence.

The following section may look different if you are currently on the MSc-year (second year) of your studies.

Top of Form

NOTE: The Advice Zone will insert the Module Code and Module Title relevant to you on your behalf.

Fill in only the sections you are applying for.

Case Study = Academic Forum
Project = Module Activity
Self-reflective Assessment = Reflective Journal
Time Constrained Assessment = End of Module Exam

Modules and Assessments

Weighting

Extension

Non-Submission
or Attendance

Original Submission
or Exam Date

Date Requested
for Submission

[Module 1 Module Code]

REGISTERED

[Module 1 Title]

Signature of
Lecturer/Supervisor * NOTE: You do not need to get your tutor's signature.

Print name:

EXAMPLE: Applying for an extension for Academic Forum and Examination only under Module 1:

Case Study 1

40%

Insert original submission deadline date

Insert extended deadline date.

Project 1

20%

Self-reflective Assessment 1

10%

Time Constrained Assessment 1

30%

Insert original examination deadline date

Insert extended deadline date

[Module 2 Module Code]

REGISTERED

[Module 2 TItle]

Signature of
Lecturer/Supervisor *

Print name:

Case Study 1

40%

Project 1

20%

Self-reflective Assessment 1

10%

Time Constrained Assessment 1

30%

[Module 3 Module Code]

REGISTERED

[Module 3 Title]

Signature of
Lecturer/Supervisor *

Print name:

Case Study 1

40%

Project 1

20%

Self-reflective Assessment 1

10%

Time Constrained Assessment 1

30%

[Module 4 module code]

REGISTERED

[Module 4 Title]

Signature of
Lecturer/Supervisor *

Print name:

Case Study 1

40%

Project 1

20%

Self-reflective Assessment 1

10%

Time Constrained Assessment 1

30%

[Module 5 Module Code]

REGISTERED

[Module 5 Title]

Signature of
Lecturer/Supervisor *

Print name:

Case Study 1

40%

Project 1

20%

Self-reflective Assessment 1

10%

Time Constrained Assessment 1

30%

[Module 6 Module Code]

REGISTERED

[Module 6 Title]

Signature of
Lecturer/Supervisor *

Print name:

Case Study 1

40%

Project 1

20%

Self-reflective Assessment 1

10%

Time Constrained Assessment 1

30%

* Confirming suitability of submission date (actual date will be confirmed by E Circs panel)

Section 7: For international (including EU) students studying on a student route VISA

VISA regulations may restrict the number of attempts or extensions to deadlines that international students can be offered and the overall time duration that you may remain in the UK. Because of this, it is essential that you speak to a USW International and Immigration Adviser before you submit your application. Please submit an email from an adviser confirming that you have been given immigration advice with your form. NB. You do not need to discuss with the adviser the reason for your claim.

☐ I am an international student and have spoken to a USW International and Immigration Adviser – I will submit an email to confirm this with my claim.

You don't need to tick this as you are an online-only student.

Section 8: Confirmation

I confirm that I have read and understood the guidance notes before completing this form. I confirm that the details contained on this form are correct to the best of my knowledge. I understand that I may be required to provide additional information in support of my claim. I understand that I cannot add modules to my request once it have been sent to the panel for consideration. The information I have provided relating to my personal circumstances or health is regarded as sensitive and private and will be treated in accordance with the confidentiality code (i.e. excluding certain exceptional circumstances) and will only be used for coordinating my claim and statistical analysis. I am aware that should my claim be successful, the decision will be made available for academic staff within the faculty to view. (Please note that personal circumstances relating to this claim ARE NOT disclosed).

DATA PROTECTION: The University of South Wales will process the personal details collected on this form strictly within the limits of the Data Protection Act 2018 and in accordance with the principles set out in the University's Data Protection Statement.

Signature of student: This can be a digital signature.

Date: The date that you filled out and submitted this form.