Faculty of Science Deferred Final Examination Request

Acknowledgement:

I confirm that I have read and understand the information regarding deferred examinations, including additional Faculty of Science specific information.

Personal information (undergraduate students ONLY)

Last name

First name

Student ID#

Laurier email (@mylaurier.ca ONLY)

Home Faculty

Number of Faculty of Science examinations that you are appealing to defer this term

Deferral information

Deferral information
	Yes	No
Have you ever previously been granted a deferred final examination in any faculty? (Yes/No)	Yes	No
Do you intend to appeal for a deferral in any other Faculty this term? (Yes/No)	Yes	No

Faculty of Science examinations that you are appealing to defer this term

Course Code & Section (i.e. CH110 A)

Course Code and Section

I am planning to graduate at the next scheduled convocation

Provide your full examination schedule for all courses this term.

Provide your <strong>full </strong>examination schedule <strong>for <u>all</u> courses this term</strong>.
	Courses this term


	Course Code (e.g. MA, PS)	Course Number (e.g. 101)	Section (e.g. A, OC1)	Final Examination Date (e.g. Dec 9)	Final Examination Time (e.g. 8:30)	Instructor (first & last name)	Type of examination (in-person, remote, take home, no exam)
Course One
Course Two
Course Three
Course Four
Course Five
Course Six

Reason that you are appealing for a deferral:
(*Note that you may not receive a response prior to the scheduled examination for appeals on medical grounds. If you are incapacitated at the time of the scheduled examination, it is presumed that you cannot attend the scheduled examination.)

In your own words, explain the personal extenuating circumstances that make/made it impossible for you to write your examination on the scheduled date. Provide sufficient accurate information for us to clearly understand the circumstances. Misleading information provided in a petition submission is considered a serious academic offense. Statements that include content copied from Generative AI tools (e.g. Chat GPT) may not be considered favourably by the Petitions Regulations Committee.

Self Declaration

If you have never previously been granted a deferred final examination:

I self-declare that I have fully explained the extenuating circumstances that made/makes it impossible for me to write my examination on the scheduled date. I have legitimate documentable reasons (as described in the procedures for deferrals and according to university regulations.)
I understand that a self-declaration does not guarantee that the deferred examination request will be granted. I am aware that I can only use self-declaration once in my entire undergraduate career at Laurier.

Supporting documentation

Supporting documentation, from an official source and specific to the date of the scheduled examination, is required for ALL extraordinary personal circumstances, except for petitions based on medical grounds. However, you may elect to submit medical documentation to support your appeal.

Photos and screenshots WILL NOT be accepted. Only scanned documents (pdf format) are acceptable for electronic submission. There are free scanning apps available including Microsoft Lens. Should documentation of an unacceptable format be submitted, your will be requested to re-submit the entire form wit appropriate supporting documentation. You should keep the original document as it may be requested.

The re-deferral of a final examination is infrequently granted. A student is expected to write a deferred examination as scheduled. Supporting documentation, specific to the scheduled date of the deferred examination, is required for all re-deferral petitions, including those on medical grounds.

Are you submitting supporting medical documentation for physical or mental health grounds?

Yes (I attest that I was incapacitated by a medical condition that was verified by a medical professional.)
No (I attest that I was incapacitated by a medical condition, that could have been verified by a medical professional, on the scheduled date of my final examination. I certify that the information provided on this form is true and accurate.)
N/A (appealing for non-medical reasons)

Supporting documentation upload #1

Supporting documentation upload #2

Are you registered with Accessible Learning for exam accommodations

Yes (I understand that I am required to follow the procedures set by Accessible Learning (AL) to schedule the deferred exam
No
Prefer not to disclose

Acknowledgment statement

I understand that a nonrefundable deferred examination fee will be charged to my account for each exam upon submission of this form.
I understand that fraudulent or misleading information, and/or altered supporting documents provided on or with my petition submission is considered a serious academic offense and will result in immediate denial of my petition. Allegations of academic misconduct will also be considered by the Associate Dean for possible further penalties.

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