ERF: Extension Request Form (2009-10)

Please note that this form is for assessment extension requests only, please read the notes
overleaf carefully before completing this form. Completed forms should be submitted to your
School Office, ARC (or equivalent) (or Department where notified) at least 7 days before the
assessment deadline.

School of registration: Department:

Surname: Programme:
Forename(s): Year of study:
Student number (as shown on ID card): Candidate number (if known):

NATURE OF MITIGATING CIRCUMSTANCES (Please tick).

Illness Death of close Accident Family Illness Other unforeseen circumstances

relative

Please give brief details of the nature of your mitigating circumstances:

(Please note that this information will remain confidential to the Academic Services and the Board of Examiners)
CERTIFICATION (Please answer the following questions)
[1] Is a medical certificate (in the case of illness) or other documentary evidence attached (please tick)? YES NO
[2] If you have answered NO, please say when you will be able to supply corroborative evidence, OR explain (here) why you are not be able
to do so:

DETAILS OF ASSESSMENT DEADLINE(S) AFFECTED

Module Assessment Element Date of Assessment Deadline

Code (eg essay, portfolio, assignment, dissertation)

I wish to apply for an extension to the assessment deadline(s) and I wish the relevant Boards of Examiners to take into account my mitigation in
relation to the above modules. I declare the information I have given to be true, and understand that the College regards the submission of false
mitigation as a very serious examination offence.

Candidate signature: __________________________________ Date: _______________________________

----------------------------------------------------------------------------------------------------------------------------------
School Office, ARC (or equivalent) use only
Please complete the relevant sections below and return to the candidate as proof of submission.

Date ERF Received: _______________________ Received by: ______________________________

Two copies provided? Y N Medical/Documentary evidence attached? Y

Yes N

Office Stamp
Candidate’s copy
 Notes for candidates on the submission of an Extension Request Form (ERF)

When should you complete this form?

If you wish to request an extension to an assessment deadline because of illness or other good cause. (If this is the case, you must
submit your application at least 7 days before the deadline – this is to allow sufficient time for your application to be considered
and for you to be notified of the decision.

Do NOT complete this form if due to illness or other good cause:

(i) you want withdraw from an examination/assessment

(ii) you have been absent from an examination/assessment or missed an assessment deadline

(iii) you entered an examination/assessment but were unable to complete it

(iv) you completed an examination/assessment but feel that your performance was adversely affected.

IF ANY OF THE ABOVE (i to iv) SCENARIOS APPLY YOU SHOULD COMPLETE A STANDARD MCF (Available
from School Offices (or equivalent)

Where do you take the completed form?

Once you have completed the form and assembled your documentation you should make two copies, one to keep for yourself and
one to submit with the originals to your School Office. Upon receipt of the completed ERF the School Office (or equivalent) will
complete the relevant section and return the ‘Candidate’s Copy’ of the form to you, this is your proof of submission and should be
retained. A copy of the form and the original documentation will be forwarded to the relevant Programme/Part Board Chair (or
nominee) a further copy will be kept on your student file. The Programme/Part Board Chair (or nominee), acting on behalf of the
Board, will consider requests for extensions.

How will a decision be reached?

The Programme/Part Board Chair (or nominee), on behalf of the Board, will only consider the evidence you have submitted to
accompany this form. You should note that there is no automatic right to an extension. The Programme/Part Board Chair (or
nominee) will consider each case on its merits in light of any precedents that may have been set. The Programme/Part Board
Chair (or nominee) will also need to be satisfied that a number of criteria or conditions have been met. They must be satisfied:

• that the circumstances are true (you are therefore required to submit all supporting evidence, such as medical certificates,
in order to satisfy the Board of the veracity of your mitigation. Self-certification of illness is not acceptable. You should also
note that the College regards the submission of false mitigation as a very serious assessment offence);

• that the circumstances constitute good cause (this is a matter for the Chair’s (or nominee’s) judgement, and it will
consider, for example, to what extent the circumstances were out of your control, the severity of any illness, and whether
you have exercised sound judgement in determining your own priorities.

• that the circumstances would render you unfit or unable to complete the assessment by the deadline (this a matter for
the academic judgement of the Programme/Part Board Chair (or nominee)

• that the circumstances would have a significant and adverse impact on your performance (this is a matter for the
academic judgement of the Programme/Part Board Chair (or nominee), and they will consider to what extent your
circumstances would affect a typical student)

What powers does the Programme/Part Board Chair (or nominee) have?

Where the Programme/Part Board Chair Board (or nominee) is satisfied that all the criteria have been met, your mitigating
circumstances will be accepted, your application will be approved, and a revised assessment deadline will be determined by the
Programme/Part Board Chair (or nominee).

For further information please see section 26 of the Regulations for examinations, and the document ‘When things go
wrong: guidelines for students’ which is available from the Policy zone on the College website and also in your
departmental or programme handbooks. For specific advice on the completion of this form, please contact your School
Office, ARC (or equivalent), or e-mail regulations@kcl.ac.uk.
School Office/ARC/Dept use only
Date received: ______________________________ Received by: ______________________________

Two copies Yes No

provided?

Are the modules/courses listed on the ERF owned by Yes No

more than one School?

If yes, which other School(s)? __________________________________________________________

Date copy of ERF sent to relevant School Offices/ARC: _________________________________________

(1) Date sent to Programme/Part Board Chair (or nominee) : ________________________

Name of Programme/Part Board: (or nominee) ____________________________________

(2) Date sent to other Programme/Part Board Chair (if applicable): _______________________

Name of other Programme/Part Board: _____________________________________________________

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

Date additional information received (where applicable): _______________________________________

Nature of additional information: __________________________________________________________

Date additional information sent to Programme/Part Board Chair(s) ________________________________

[and other School Office(s) where applicable]:

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

Date decision received from Programme/Part Board Chair (or nominee) _________________

Date decision received from other Programme/Part Board Chair (or nominee) (if applicable):

___________________________________

Date candidate notified of decision: _________________________________________________________

 Date received: _______________________
Chair’s (or nominee’s) use only

Please note that this form should only be used by candidates wishing to apply for an extension in
advance of an assessment deadline; applications for retrospective extensions or replacement
examinations should be made on the MCF.

Please refer to the Assessment Framework web pages for further information
(http://text.kcl.ac.uk/about/structure/admin/acareg/qaaa/assessment/framework/index).

Please complete the check list below. Once completed, sign and date the form at the bottom and return to your School
Office/ARC (or equivalent). For all regulatory advice please contact Academic Support & Quality Section
(regulations@kcl.ac.uk) and for advice on completing this form, contact either your School Office or Academic
Support & Quality Section (regulations@kcl.ac.uk)
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Applications for an extension in advance of an assessment deadline to be considered by the Chair (or nominee)
Check list:
i) Has the candidate submitted the mitigation at least 7 days before the assessment deadline? Yes No

ii) Am I satisfied that the circumstances are true? Yes No

iii) Am I satisfied that the circumstances constitute ‘good cause’? Yes No

iv) Am I satisfied that the circumstances render the candidate unfit/unable to complete the Yes No
assessment by the deadline?

The application for an extension should normally be granted only where you have answered ‘Yes’ to all the above.

The application is (please tick the appropriate box): approved rejected

If approved, please give the revised assessment deadline and details of any special arrangements:

Module Assessment Element Revised Arrangements (ie electronic submission,

Code (eg. essay, assignment, Deadline additional copies to be submitted etc)
portfolio, dissertation, report)

Decision approved under Chair’s action

Name of Chair (or nominee): ______________________________________ Date mitigation considered: __________________

Signature: ___________________________________ Programme/Part Board: ________________________________