Fillable Request for Academic Relief: Compassionate Grounds (Brescia University College)

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Request for Academic Relief: Compassionate Grounds (Brescia University College)

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Country of origin: CANADA
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Request for Academic Relief: Compassionate Grounds
A request for academic relief on compassionate grounds will be considered only if there is a
direct and unavoidable conflict between the event and the course component.
Decisions will be made by the Academic Advisors in consultation with the Academic Dean.
Please fill out the following Information and attach supporting documentation to this form.
Documentation must dearly Indicate the dates of the missed material.
Student Name
Student Number
Western Email
Are you a Brescia student? Yes No
Class Information
Course & Course
Number
eg. Psych 3209G
Professor’s
Name
eg. Jane Doe
Professor’s
Email
eg. jdoe@uwo.ca
Course Work
Missed
eg. Essay
Due Date of Missed
Course Work
eg. Nov. 1, 2020
Please indicate the extenuating circumstances that would prevent you from completing the
assigned work:
Do you write your exams with Accommodated Exams Service (as per SSD recommendations)?
Yes No
Final Exam? Special Exam Form Required? Yes No
Student received Special Exam Form: _______________________________________________
Student Signature: ______________________________________________________________
Date: _________________________________________________________________________
INCOMPLETE FROMS WILL NOT BE PROCESSED
Once approved, it is the responsibility of the student to make alternative arrangements with
the instructor. These arrangements must be made as soon as possible.
Once complete, please email to brescia@uwo.ca
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Request for Academic Relief: Compassionate Grounds (Brescia University College)

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Completed 7 July 2021

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