Fill - Free fillable Deferredstanding Deferred Standing Request Form PDF form

J:\STUDENT\GraduationandPublications\Publications\Forms\Withdrawals‐AEG,DE,Medical\deferredstanding.pdf 02/2016 Page1of2

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DeferredStandingRequestForm

Registrar&EnrolmentServices

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IMPORTANTINFORMATION

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Noappealwillbeconsideredwithoutdocumentaryevidenceofextenuatingcircumstances.

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Studentswhoareunabletocompletecourserequirementsduetoextenuatingcircumstancesmayapplyto

theRegistrarforadeferredstanding.

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DEADLINE:Thedayafterthelastdayoffinalexams.

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FromPolicyE2011:WithdrawalfromCoursesandDeferredStanding

 Deferredstanding(DE):anarrangementidentifiedbyatemporarynotation(DE)onastudent’stranscript

thatindicatesthatthestudenthasbeengrantedanextensiontocompletecourserequirementsbecause

ofextenuatingcircumstances.

 Extenuatingcircumstances:compassionateandexceptionalcircumstancesbeyondastudent’scontrolthat

significantlyaffectthestudent’sabilitytomeetrequirementsofacourse.Suchcircumstancesmay

includethoserelatedtoastudent’sphysicalorpsychologicalhealththatisverifiableanddocumentedby

anappropriatelistedprofessional.

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Itisthestudent’sresponsibilitytoreadandunderstandPolicyE2011:WithdrawalfromCoursesand

DeferredStanding,availableontheLangaraCollegewebsiteat:http://langara.ca/about‐langara/

policies/college‐policies/student‐services.html

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OFFICEUSEONLY

DECISION:

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COMMENTS:

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INITIAL: DATE:

J:\STUDENT\GraduationandPublications\Publications\Forms\Withdrawals‐AEG,DE,Medical\deferredstanding.pdf 02/2016 Page2of2

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DeferredStandingRequestForm

Registrar&EnrolmentServices

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PARTA:TOBECOMPLETEDBYTHESTUDENT

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PARTB:TOBECOMPLETEDBYANAPPROPRIATEPROFESSIONAL(IFAPPLICABLE)

FULLLEGALNAME:

LANGARAID: TERM:

PHONE: EMAIL:

Iwishtobeconsideredforadeferredstandingforthefollowingreason(s)(attachmaximum2pagedocumentexplainingcircumstances):

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Iwishtobeconsideredforadeferredstandingforthefollowingcourse(s):

COURSESUBJECTANDNUMBER:

EXAMDATE:

(IfmissedFinalExam)

COURSEWORKSTILLREQUIRED:





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RELEASEOFINFORMATION:LangaraCollegecollectsyourpersonalinformationundertheauthorityoftheCollegeandInstituteAct

[RSBC1996,Chapter52,Section41.1]forthepurposeofprocessingyourdeferredstandingrequest,andincompliancewiththe

provisionsoftheFreedomofInformationandProtectionofPrivacyAct[RSBC1996,

Chapter165,Section33.1].Forquestions

aboutthecollection,useanddisclosureofyourpersonalinformation,contacttheRegistrarofEnrolmentServicesat604.323.5225.

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STUDENT’SSIGNATURE:DATE:

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AnappropriateprofessionalisanAboriginalElder,anindividualwhoisregisteredwiththeCollegeofPhysiciansandSurgeonsof

BC,aDentistregisteredwiththeCollegeofDentalSurgeonsofBC,aregisteredpsychologistoftheCollegeofPsychologistsofBC,

aNursePractitionerregisteredwiththeCollegeofRegistered

NursesofBC,aRegisteredClinicalSocialWorkerregisteredwiththe

BCCollegeofSocialWorkers;oranequivalentregisteredprofessionaloutoftheProvince.

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Thisstudentisunabletocompletecourserequirementsonthedate(s)from______________________to___________________

duetoanextenuatingcircumstance,andinmyopinionshouldbeconsideredforadeferredstanding:☐Yes☐No

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REASONSFORDEFERRAL(CONFIDENTIAL):

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PROFESSIONAL’SSIGNATURE: DATE:

PROFESSIONAL’STITLE:

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STAMPORPRINTPROFESSIONAL’SNAMEANDADDRESS:

Mark“Confidential” andsubmitcompletedform to:

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Appeals,RegistrarandEnrolmentServices,

LangaraCollege,100West49

Ave.,Vancouver,BC,V5Y2Z6

Fax:604.323.5590

Email:appeals@langara.ca

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