Academic Consideration for Coursework Form

Academic Consideration for Coursework Request Form

Students are to complete this form if instructed to do so by their instructor for short term requests as per the Academic Consideration Policy. Students should consult the course syllabus about the instructor’s policy or procedures for requesting academic consideration.

Coursework is defined as academic work assigned to students not including formally scheduled final examinations and take-home exams. Requests for accommodations during the formal exam period must follow the official deferral process.

As per the Academic Consideration Policy, if students encounter extenuating circumstances that temporarily hinder their capacity to fulfil in-class academic requirements for a period that is five days or less, they can request academic consideration as per the following instructions:

Consult the course syllabus about the instructor’s policy or procedures for requesting academic consideration.
Contact your instructor(s) as soon as possible and normally no later than 24 hours after the submission deadline.
Fill out this form as requested
Complete and submit course work per academic consideration, if granted.

Extenuating circumstances are circumstances that:

are beyond a student’s control
have a significant impact on the student’s capacity to meet their academic obligations; and
could not have reasonably been prevented

Student Name*
First Last
Student Number*
Student Carleton email Address (@cmail)*
Course Code & Section (ex: PSYC 1001A)*
Coursework Requiring Academic Consideration*
Coursework Deadline*
Nature of Illness or Extenuating Circumstance (medical, other, N/A)*
Note: transit issues, competing deadlines, personal social obligations, employment obligations and travel do not constitute extenuating circumstances.
Instructor Name*
First Last
Instructor Email*
Enter Email Confirm Email
Confirm each of the following with a checkmark.*
- I certify that I missed/will miss the scheduled course component(s) listed above due to short-term incapacitation as described 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 understand that by completing and submitting this 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.
Section VI.4 of the Academic Integrity Policy is available at the Secretariat website.

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