OFFICEUSEONLY
DateReceived: _________________
PCInitial: _________________
HCOTOI/WO
Approved:Denied:
EmailStudent: ES/ORS:
DEFERREDEXAMREQUESTFORM
LastName:
FirstNam
e:
StudentID#:
EmailAddress:___________________________@uoguelph.ca
ENGGMajor:
StudentAccessibilityServicesrequired? YES NO
NOTE:ITISTHESTUDENT’SRESPONSIBILITYTOARRANGEACCOMMODATIONSWITHSAS
SEMESTER
(eg.W20)
COURSECODE
(eg.ENGG*2450)
SECTION
NUMBER
(eg.0101)
DATEOFMISSED
EXAM
(yyyy-mm-dd)
Su
pportingDocumentationAttached(MedicalNote,LetterfromCounsellor,etc.)
(REQUIREDFORALLREQUESTS)
Date:
StudentSignature:
Note:Studentsmustcompleteadeferredexambytheendofthesemesterimmediately
followingthecompletionofthecourse.Studentsmaybeblockedfromregisteringincourses
untilthedeferredexamiswritten.Forexample,falldeferredexamsmustbecompletedbythe
endofthesubsequentwintersemester.
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