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Coventry University Date of Receipt

Extension and/or Deferral application form
PLEASE COMPLETE ALL SECTIONS AND SUBMIT TO YOUR FACULTY
REGISTRY EITHER IN PERSON OR BY EMAIL BEFORE YOUR ASSESSMENT(S).

Please read the below information and read the separate Student Guide to Extension and Deferrals document
before you complete this form:

 A deferral may mean that you will complete a brand new assessment task at the next submission period. This may
mean that you may not be able to progress or graduate and may result in you finishing your studies later than
originally planned
 When you submit a final piece of coursework, or complete an exam attendance slip, it means that you consider
yourself well enough to do the assessment.
 We will not normally accept an extension or deferral request after the assessment deadline. If you are submitting after
the deadline then you must state why you were unable to apply on or before the deadline and provide evidence to
support if appropriate. If you do not, then your application will be rejected.
 If you requested an extension and you have not had confirmation that your application has been approved, you
should submit your assessment on the requested extended deadline date and contact your Faculty Registry to advise
them of this. If your application is valid and you have supplied the correct evidence, your application will be approved
and your work will be accepted and marked as on time.
 Any student who knowingly submits false or forged evidence at any stage of an extension or deferral application
forfeits their right to consideration of the case and renders themselves liable to disciplinary proceedings. The
University reserves the right to check the authenticity of evidence submitted and by signing/submitting electronically
the extension/deferral form you are agreeing to this.

Family Name Abdelnabi ID Number 9118128

Forename(s) Mohamed

University Email address (all communication will be sent to this address)

Abdelnam@uni.coventry.ac.uk
Course (e.g. BSc Psychology and History) Stage & Faculty
Mechanical engineering Start Month EEC-MAA
(1, 2, 3 etc)
10
PART A: Complete all sections of the table and tick the extension or deferral box to
show what you are asking for.
If you have a Tier 4 visa, check whether a deferral will affect the length of your course and your visa – email
visahelp.io@coventry.ac.uk
Mod Module title Comp Coursewo Extension Deferr
ule onent rk in working al
code (cw1, submissio days
Ex, n
Prs) date/date 5 10
of day days
examinati s
on
3005 Fluids and heat transfer Cw1 18/11/2020 10
MAA days

PART B:
Please tick the reason for your request and provide independent evidence. Please
note that evidence from an online doctor will not be accepted. You must submit this
form before your deadline date and you can submit evidence up to 5 working days
after. If we have not received your evidence within 5 days we will reject your request.
Reason for extension and/or deferral Tick
here
Ill-health
(Evidenced in the form of a doctor’s note (we do not accept Push Doctor or any online
doctors notes as appropriate evidence))
Death/illness of a relative or friend
(This must be evidenced by their Doctors note or a note from your own
Reviewed September 2019
 Doctor advising how you have been affected, please note where you are
providing any information or evidence relating to the health of a relative or
friend you are required to obtain their consent. Please see Part D below.)
Unforeseen crisis during exam/test or leading up to the deadline I don’t
(The crisis must have been recorded in an invigilator’s report.) have a
laptop
so I
can’t
tick
Other
(Including personal reasons and which must be evidenced by a doctor or
medical practitioner. Please also see Part D below)

PART C:
Details: please write as much detail as possible and explain how your situation has affected you and why you
need a change of submission date - continue on a separate sheet if necessary.

o i’m struggling to proceed on my coursework because of the events going around and their was miss
communication between group members while the module leader was aware of

Medical/Other evidence attached YES / NO / NOT APPLICABLE

(explain the reason if no evidence is attached)

Signature of student Date:10/11/2020

Mohamed adel
I have seen the independent evidence and approve the Signed:
extension and/or deferral.
Print Name:

Date:
I have seen the independent evidence and do not approve Signed:
the extension and/or deferral.
Print Name:
My reasons for not approving this application are:
Date:

PART D – CONSENT
If you consider it necessary to send personal evidence in relation to a family member or other person, which includes
information relating to their health such as medical certificates or doctors notes, or where it includes information about
their race, ethnic origin, religious or philosophical beliefs, trade union membership, sex life or sexual orientation, or
where it includes any genetic or biometric data or information relating to criminal convictions or offences (“Sensitive
Information”) you are required to obtain their consent to our use of this information (as to which see below). Please
note we do not require consent from any family member or other person to use any information which they provide
other than that specifically detailed above. All personal information provided by a family member or other third party will
be processed in accordance with our Extension and Deferral Request Privacy Notice for Third Parties which is annexed
to this form.
It is important to note that if we do not receive permission consent to use the specific information listed above, this will
be returned directly to you. We will not retain copies and will not be able to consider this in relation to your academic
appeal. This is in line with the General Data Protection Regulations 2016 and the Data Protection Act 2018.
Third Party Consent:
I, _____________________________, hereby consent to the Sensitive Information about me which is submitted in
relation to this application, including information relation to my health, race, ethnic origin, religious or philosophical
beliefs, trade union membership, sex life or sexual orientation, criminal convictions or offences or any information
containing genetic or biometric data, being processed by purpose of this application.

Signed:

Reviewed September 2019

 Date:

Address

Telephone:

Email:
To the person named above:
Please note you have a right to withdraw this consent at any time by sending an email to enquiry.igu@coventry.ac.uk. All
personal information which you provide to us will be handled in accordance with our Academic Appeals Privacy Notice for
third Parties a copy of which is annexed to this form and which can be viewed online at Extensions and Deferrals.

Reviewed September 2019