Student Self-Certification Form
Undergraduate and Postgraduate Taught students
General Information:
Before completing this form, please ensure you are aware of your academic department’(s) procedures for reporting absence and
read the explanatory notes on extenuating circumstances: www.shef.ac.uk/ssid/forms/circs.
This form is for use by Undergraduate and Postgraduate students who need to self-certify medical and other personal
circumstances resulting in absence for LESS THAN 7 CALENDAR DAYS from their programme of study.
The University expects you to manage minor illnesses yourself, e.g. coughs, colds, sore throats.
You may be required by your academic department to self-certify absences for less than 7 calendar days. You must
therefore ensure that you are familiar with your academic department’(s) guidance on reporting absence.
The University does not normally require medical/supporting documentation for periods of absence less than 7 calendar
days; however, if you have repeated periods of absences for less than 7 calendar days academic departments may require
you to complete an Extenuating Circumstances Form and provide supporting evidence.
If you have a disclosed disability (the legal definition of a disability is ‘a physical or mental impairment which has a
substantial and long-term effect on your ability to carry out normal day-to-day activities’) and the Disability and Dyslexia
Support Service (DDSS) has passed the relevant information on to the Departmental Disability Liaison Officer, you do not
need to submit repeated Student Self-Certification forms. However, if you have missed a class where a formal register is
taken you will need to follow your department’s internal absence reporting procedures. If additional information concerning
the impact of the disability at a particular examination period needs to be considered, you should submit an Extenuating
Circumstance Form, but you would not normally be expected you to submit further written evidence. If the circumstances
are not related to your disability, you will need to self-certify or submit an Extenuating Circumstances form. Further
information on the DDSS is available via the link: http://www.sheffield.ac.uk/ssid/disability
If you have significant medical, personal or non-medical circumstances lasting more than 7 calendar days and/or feel that
circumstances have affected their performance in examinations or assessment should complete the Extenuating
Circumstances Form.
To see the Extenuating Circumstances Form and details on what may constitute mitigating circumstances, (which could
reasonably be deemed to have had a significant impact on a student’s performance in examinations and assessment and
which a departmental Examination Boards might consider) see: www.shef.ac.uk/ssid/forms/circs.
Note to Students:
You should complete sections 1, 2 and 3 and submit the form to the relevant academic or other appropriate member of
departmental staff.
If you wish any details to remain confidential you should submit this form in a sealed envelope marked for the attention of your
personal tutor or other appropriate departmental staff.
1. 1.Student
Student Details
Details
Registration Number: Are you studying in the UK on a student visa? Yes No
Family Name: First Name(s):
Student Signature: Date:
I confirm that the information I have given on this form is correct to the best of my knowledge. I understand that appropriate University
academic and support staff will have access to the information I have provided on this form
2. Details of Absence
From: To:
2 Module Information
Please provide details of the circumstances resulting in this period of absence:
2 3. Module Information
Units Affected by Absence
Please indicate which units have been affected by this absence
Unit Code Type of teaching, e.g. Date of teaching Unit Code Type of teaching, e.g. Date of teaching
lecture, laboratory, affected by the lecture, laboratory, affected by the
seminar absence seminar absence
4. For
4. Use
ForbyUse
Departmental Staff Staff
by Departmental
Appropriate departmental staff may complete this section of the form.
Departmental record loaded by: Date:
Student note loaded on DAS? YES/NO
(DAS = CIS Departmental Assessments System)
Further Comments and action taken:
UNIVERSITY STAFF: These forms are for internal departmental use only. Do not submit to the Taught Programmes Office.
