Academic Consideration for Coursework Form

Student Name*

First Last

Student Number*

Student Carleton email Address (@cmail)*

Course Code

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

Coursework Requiring Academic Consideration*

Essay/written assignment
Midterm
Test
Lab/tutorial assignment
Other

If Other: list 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.
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 in the Undergraduate Calendar ( https://calendar.carleton.ca/undergrad/regulations/ ). 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.

Section VI.4 of the Academic Integrity Policy is available at the Secretariat website.

Consent

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

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Registrar's Office

Academic Consideration for Coursework Form

Academic Consideration for Coursework Request Form