Please Ensure That You Have Read the Help Sheet for Students

PLEASE ENSURE THAT YOU HAVE READ THE “HELP SHEET FOR STUDENTS Failure to fully complete the form will result in an automatic rejection

*Official Use Only

*Date Received ………………..

*Submitted On Time: Yes / No

Retrospective Mitigating Circumstances Form 2017-18

Personal Details

Name: ...... Student ID: ...... ………………

Address for correspondence ...... ……………….

...... …………..……

...... ……………..…

Telephone No: ...... GCU Email address: …………………………@caledonian.ac.uk

Date of Submission of form:...... (This date must be entered)

When should I use this form?

You should use this form if you wish to submit a claim for Retrospective Mitigating Circumstances (RMC) after you have received your Assessment Board’s decision and it must be submitted no later than two calendar weeks after the publication of results.

You are required to provide full details of the circumstances which prevented you from submitting a Mitigating Circumstances Form (MCF) by the appropriate deadline, i.e. before the Assessment Board meeting.

RMC forms will only be accepted in exceptional circumstances. For example if you were hospitalised or very ill and unable to contact the University or you had exceptional and unforeseen personal circumstances.

All claims must include medical certificates or other documentation which explain why a MC form could not have been submitted by the appropriate deadline.

Being unaware of the MC process or dissatisfaction with academic decisions are NOT grounds for submitting a Retrospective Mitigating Circumstances form.

Please consult the Mitigating Circumstances “Help Sheet for Students” for guidance on how to complete the form. Supporting Evidence in support of the claim for Retrospective Mitigating Circumstances (This section must be completed)

Please provide full details of the circumstances which prevented you from submitting a Mitigating Circumstances form by the appropriate deadline.

 I have provided additional separate documentation as supporting evidence for retrospective consideration

 I am not submitting additional supporting evidence documentation.

Category of Attendance (Please tick the appropriate boxes)

Full-Time Part-Time Undergraduate Postgraduate

CPD Distance Learning Other (please specify):……………………………..

Programme/Module Details

Programme of Study ......

AOS Code (This is indicated on your Student ID card) ......

School:…………………………………………………………………………………………………………. (eg, GSBS, SHLS, SEBE, GCU London, GCU Lead, Graduate School SWBE)

Modules affected by Mitigating Circumstances (please complete for each module affected)

Module Module Title Date of Assessment type* Code Assessment

…………… ……………………………………………... ………………….. …………………………

…………… …………………………………………….. ………………….. …………………………

…………… …………………………………………….. …………………. …………………………

…………… ……………………………………………. …………………. ………………………….

…………… …………………………………………….. ………………….. …………………………. *eg exam, essay, dissertation etc. Nature of Mitigating Circumstances

Nature of Mitigating Circumstances Medical Other (please tick box)

Duration of impact of Mitigating Circumstances (start date) ______to ______(end date)

Supporting Evidence for Mitigating Circumstances

This is separate from evidence supporting the retrospective element of your application and must be completed.

You must provide supporting evidence and it must clearly relate to the specific dates during which the Mitigating Circumstances were applicable. If you are awaiting supporting evidence documentation, do not delay submission of the form. If you submit the RMCF without supporting evidence, the supporting evidence documentation must be submitted no later than 5 working days after the deadline and you must supply your personal details with the documentation. Please refer to the “Help Sheet for Students” for further guidance (Section 7 “What evidence do I need to attach to my form?”)

Please tick the appropriate box

 I have provided additional separate documentation as supporting evidence consisting of

______(please specify, e.g. medical certificate,) OR  I am awaiting additional supporting evidence documentation (it is your responsibility to submit this within 5 working days of the deadline) OR

Staff Use Only – please confirm evidence received

Personal Impact Statement

You are required to include details of how the circumstances have affected your studies. Please provide as much information as you feel the Board needs to know to allow it to make a decision and which you feel comfortable disclosing. Please continue on a separate sheet if necessary. Please refer to the Help Sheet for Students for further guidance (Section 6 “What sort of information should I include?”) DECISION OF RETROSPECTIVE MITIGATING CIRCUMSTANCES BOARD

PART ONE: STUDENTS TO COMPLETE PART ONE

NAME STUDENT ID

ADDRESS AOS CODE on Student ID card

FULL TIME PART TIME

PROGRAMME NAME

PART TWO: To be completed by a member of the Mitigating Circumstances Board

Claim Accepted (noted with an X in the box) Your application for Retrospective Mitigating Circumstances has been accepted and will be considered by the Assessment Board. Your application for Retrospective Mitigating Circumstances has been accepted on this occasion and will be considered by the Assessment Board You should contact the Disability Service, as this may not be considered an acceptable mitigating circumstance in the future www.gcu.ac.uk/disability

Claim Rejected The Retrospective Mitigating Circumstances Board REJECTED your claim on the following grounds (noted with an X in the box)

1. You did not submit the form within the stated deadline (2 weeks after the publication of Assessment Board decision). 2. Your justification for a retrospective application was not accepted.

3. Your mitigating circumstances did not meet the criteria as stated in the guidance. 4. Your Personal Impact Statement did not contain sufficient information to allow members of the Board to judge the validity of your claim. 5. The evidence you provided did not provide sufficient information to validate your application. 6. The evidence submitted was not judged to have come from an appropriate external third party (such as a medical Doctor). 7. The dates on your form did not coincide with the dates of assessment.

8. You were not enrolled for the module which had been affected by the mitigating circumstances. 9. Other Grounds (details below)

I declare the outcome of the Retrospective Mitigating Circumstances Board as noted above to be accurate.

Signed by a member of the RMC Board: Date:

………………………………………………………………………………………

The decision of the Mitigating Circumstances Board is final and there is no right of appeal or opportunity to submit further evidence. COPY OF FORM TO BE RETURNED TO STUDENT, ORIGINAL FORM TO BE RETAINED IN SCHOOL PLEASE ENSURE THAT YOU COMPLETE “PART ONE” OF THE DECISION FORM ON THE PREVIOUS PAGE. NO FEEDBACK WILL BE PROVIDED UNLESS THIS IS COMPLETED

Claims for retrospective mitigation will not be deemed valid if:  The form is incomplete.  The form is submitted after the deadline detailed on page 1 of the form.  The form is not accompanied by relevant supporting information.

Declaration

The information given in this form must be accurate and must have, or must be believed to have, had a direct and adverse effect on your academic performance. If you provide information or certificates which are subsequently found to be falsified or misleading in any way, you may be liable to action being taken against you under the Code of Student Conduct.

You MUST sign and date this declaration:

The information I have given on this form is, to the best of my knowledge, true and has had a direct adverse effect on the assessment(s) named.

Signed: ...... Date: ………………………...

October 2017