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UNIVERSITY OF CANTERBURY

Application for Special Consideration (Impaired Performance/Missed Assessment)

You can use this form to apply for Special Consideration if you have covered the work of a course but have been prevented from demonstrating your knowledge or skills at the time of the assessment due to unforeseen circumstances.

Section A - Student details

First Name

Last Name

Student ID

Email Address

Enrolled Qualification

Specify your own value:

Section B - Course details - To add a second assessment, select Add new row

This assessment will take place in the future. You are encouraged to attempt the assessment if possible, and apply for impaired performance.

Grounds for this application

Covid-19
Medical
Bereavement
Other Circumstance

Please provide a detailed description of the grounds for the application and the impact on your study *

All applications must provide an explanation in section B for non Covid-19 related medical applications, an application based on medical grounds must have a SC Medical Form completed by an approved medical practitioner as listed in the policy.

If you experience problems obtaining medical evidence at this time please let us know by providing details in the description box.

In the case of bereavement, appropriate evidence may be a death notice from a newspaper or a letter from a medical practitioner, Religious leader, Kaumatua or the Police. Where the notice or letter does not indicate the relationship of the deceased to the applicant, the applicant should attach a letter from a friend or relative stating the relationship or connection.

In cases of other critical circumstances, supporting evidence will depend on the nature of the circumstances, independent supporting evidence should be provided where possible, and this might include Police reports, medical certificates or letters from others concerned in the situation.

Provide Now
Provide Later

Evidence to support your application is expected within 10 working days of your application being submitted.

If this is not possible, please contact us to discuss further at specialconsideration@canterbury.ac.nz

Attached Document(s)

Add Attachment

Section C - Declaration

The information supplied in this form and the supporting material will be used for the purpose of assessing your Special Consideration application. It will be made available to the Special Consideration Committee, medical assessors, the Heads of the relevant departments/schools and any committee or person concerned in the determination of Special Consideration Applications. Where applicable, information supplied in this application may be verified with the medical practitioner. This application will be retained by the University and may inform future decision-making if subsequent applications for special consideration are made.

By submitting this application, you agree to the following declaration:

I consent to the information in this application being made available to the persons, and used for the purposes, stated in the preceding paragraph. I consent to the University verifying information contained in this application (where applicable).

I have read the information for special considerations and to the best of my knowledge, I am eligible to seek special consideration for the assessments listed above. To the best of my knowledge, the information contained in this application is true and correct.

Yes I agree with the above statement

In considering your application, the committee may recommend referral to one or more of the University's support services. Please indicate whether you agree to your information being shared with UC Support Services.

Yes I agree to be referred to other support services
No I do not want to be referred

SP2016 - 18/01/24