RETAIN COPIES 2 & 4 FORWARD 1& 5 TO ABOVE DEAN’S/DIRECTOR’S REPRESENTATIVES
DATE RECEIVED_________________ 20_______ COPY 5 MAILED TO STUDENT _______________ 20______ INITIALS _________
THIS SECTION TO BE COMPLETED BY THE DEAN’S/DIRECTOR’S OFFICE OF THE STUDENT’S FACULTY/SCHOOL TO ACKNOWL-
EDGE THE DEPARTMENTS DECISION.
MONTH / DAY / YEAR
DATE:
SIGNATURE OF DEAN’S/DIRECTORS REPRESENTATIVE:
FORWARD COPIES 1 & 5 TO THE REGISTRAR’S OFFICE
THIS SECTION TO BE COMPLETED BY THE REGISTRAR’S OFFICE
COMMENTS :
RETAIN COPY 1 AND FORWARD COPY 5 AND RELEVANT INFORMATION TO STUDENT
THE UNIVERSITY OF MANITOBA
WINNIPEG, MANITOBA R3T 2N2
DEFERRED EXAM FORM
THIS SECTION TO BE COMPLETED BY THE DEAN’S/DIRECTOR’S OFFICE OF THE STUDENT’S FACULTY/SCHOOL UPON
RECEIPT OF A MEDICAL CERTIFICATE OR OTHER ACCEPTABLE EVIDENCE OF STUDENT’S INABILITY TO SIT FOR THE
EXAMINATION. COMPLETE
ONE FORM FOR EACH DEFERRED EXAMINATION GRANTED.
FALL TERM -20 WINTER TERM -20 SUMMER TERM -20 CORRESPONDENCE
FACULTY
PROGRAM MAJOR
STUDENT
NUMBER
NAME
PHONE
CURRENT
ADDRESS
SUBJ.
CODE
COURSE
NO.
SECTION
NUMBER
INSTRUCTOR
DEFERRED EXAMINATION PRIVILEGE GRANTED FOR FOLLOWING REASON: (CHECK ONE ONLY)
MEDICAL
COMPASSIONATE
WAS EXAMINATION DEFERRED PREVIOUSLY?
YES
NO
WILL THIS COURSE COMPLETE DEGREE REQUIREMENTS?
YES
NO
WHAT IS THE EARLIEST DATE THE STUDENT WILL BE ABLE TO WRITE THE EXAMINATION?
MONTH / DAY / YEAR
THIS IS ONE OF ________ DEFERRED EXAMS. DATE
MONTH / DAY / YEAR
SIGNATURE OF
DEAN’S/DIRECTORS
REPRESENTATIVE
RETAIN DEAN’S/DIRECTOR’S COPY 3 AND FORWARD 1,2,4,& 5 TO HEAD OF DEPARTMENT OFFERING THE COURSE
CITY
PROVINCE
POSTAL
CODE
MONTH / DAY / YEAR
THIS SECTION TO BE COMPLETED BY THE HEAD OF DEPARTMENT WHO WILL ELECT ONE OF THE FOLLOWING ALTERNATIVES.
THE STUDENT WILL:
1.
WRITE AN EXAMINATION DURING A REGULAR EXAM SERIES
2.
WRITE AN EXAMINATION OF
1 2 OR
3
HOURS DURATION, TO BE ARRANGED BY THE DEPARTMENT
A) EXAM TO BE WRITTEN
MONTH / DAY / YEAR
LOCATION
BUILDING ROOM NO.
TIME_______________
A.M.
P.M.
OR
B) STUDENT TO CONTACT INSTRUCTOR AND/OR DEPARTMENT AS SOON AS
POSSIBLE TO ARRANGE FOR AN EXAMINATION TO BE WRITTEN NO LATER THAN
MONTH DAY
20
3.
BE GRANTED STANDING IN THE COURSE WITH A GRADE OF _______ THE DEPARTMENTS BEING SATISFIED THAT THERE IS A
REASONABLE ASSURANCE THAT IF THE STUDENT HAD WRITTEN THE FINAL EXAMINATION THIS GRADE WOULD HAVE BEEN ACHIEVED. IF
THE STUDENT FINDS THIS UNACCEPTABLE, #1 OR #2 MAY BE ELECTED BY CONTACTING THE DEPARTMENT WITHIN 21 DAYS FROM DATE
THIS FORM IS MAILED TO THE STUDENT.
DATE: SIGNATURE OF HEAD OF DEPARTMENT:
SPECIFY EXAM SERIES : DECEMBER APRIL SUMMER
DEPARTMENT
ENTER TWO CRN’S IF THIS IS A SPANNED COURSE
CRN CRN
