Long Term Academic Consideration Form

Long Term Academic Considerations for Coursework Form

Student Name(Required)

First Last

Student Number(Required)

Carleton Email Address(Required)

List the impacted course(Required)

Course Code (ex: PSYC) Course Number and Section (ex: 1001A)

Coursework Requiring Academic Consideration(Required)

Essay/written assignment

Midterm

Test

Lab/tutorial assignment

Other

If other, indicate the coursework requiring academic consideration

Coursework Deadline(Required)

MM slash DD slash YYYY

Nature of Extenuating Circumstance(Required)

Instructor Name(Required)

First Last

Instructor Email(Required)

Enter Email Confirm Email

Declaration

Please read and check each box:(Required)

I certify that I missed/will miss the scheduled course component(s) listed above. I understand and acknowledge that providing false or misleading information in order to avoid or delay the submission of work or to avoid an exam is a violation of section VI.4 of the Academic Integrity Policy and is subject to an Academic Integrity review.

I understand that deferring the course components listed above may result in a negative impact to my academic performance. I will consult with an academic advisor as needed and be sure that I am aware of the academic withdrawal deadline and, as always, assess my continuation in my courses before that deadline.

I certify that I have read all of the above information and followed all of the steps indicated.

I certify that I will email supporting documentation to AcademicConsideration@cunet.carleton.ca

I understand that by completing and submitting a Long Term Academic Consideration for Coursework Form I am authorizing the Registrar’s Office to contact those who have provided documentation submitted with my application, including but not limited to medical documentation, for purposes of verifying authenticity.

By submitting this form, I acknowledge that this is a request and that it is not automatically approved.

Rules and regulations around deferring term work can be found in section 4.4 of the Undergraduate Calendar. Please note that in the event the altered due date goes beyond the last day of the term, the instructor will assign a grade of zero for the work not submitted and submit the final grade accordingly. Since there is no missed deferred process for term work, if you do not submit the work by the date specified by your instructor, your grade will remain a “0” for that work.

Date

MM slash DD slash YYYY

Consent

By submitting this form, you acknowledge that you have read the privacy notice.

If you have any questions regarding your academic consideration request, please contact your instructor. The course instructor will determine any academic consideration for all in-class academic deliverables excluding formally scheduled and take-home undergraduate final exams. Undergraduate students that require accommodations for final examinations must follow the Deferral application process.

Additional Comments

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