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Deadline Extension Form

Student Name:
Student ID:
Course:
Unit/Subject:
Lecturer:
Assignment Name/No:
Reason for deadline extension:

Supporting evidence provided: (*tick as appropriate)

Medical Evidence* Counsellor Form* Employer Report*
Other* (please specify below)

I consent that the details given on this form and the supporting evidence attached be presented to the Lead Internal Verifier responsible for my course.

Student Signature:
Date


Data Protection Act 1998

The data that you have provided on this form will be used by Semester: Learning & Development for the purpose(s) of requesting a deadline extension will not be passed on to any third party not directly involved in these activities without your permission. The data will be stored securely and only used for the purpose(s) originally intended.

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