University of Hull

Hull, HU6 7RX

United Kingdom
E: student-admin@hull.ac.uk
T: 01482 465032

COURSEWORK EXTENSION REQUEST FORM

Before completing this form please ensure that you have read the University’s Mitigating
Circumstances Code of Practice. This can be located on SharePoint. It is strongly
recommended that you discuss your situation with your Academic Support Tutor.

This form must be submitted to your Student Hub, 24 hours before the assessment
deadline. Late extension requests will not be considered. You must provide supporting
documentary evidence to support your request.

You will normally be informed of the outcome of your request via email. If your extension request
is not accepted you will need to submit your work by the original deadline date.

PART 1 – STUDENT DETAILS

Student Name Adrian Lucian Gorgan

Student ID Number 201724749

Programme EMBA
Year/Level 2017

PART 2 – EXTENSION REQUEST DETAILS

Module Title and Module Code Original Submission Requested

Course work details Date Submission date
Human Resource 56489 5 Sep 2018 15 Sep 2018
Management

PART 3 – REASON FOR EXTENSION REQUEST

Please provide full details of the reason for your request:

In order to benefit from the eMBA program I started an IT company a few months ago,
this time the company’s activity interfered with the time needed to complete my study.

PART 4 – DOCUMENTARY EVIDENCE

List of documentary evidence attached

PART 5 – CHECKLIST

Before you submit your form please check you have:

Completed the module details and deadline dates ok

Explained clearly the reasons for your extension request ok
Attached and listed documentary evidence -

PART 6 – DECLARATION
I declare that the information provided on the form is accurate and complete to the best of my
knowledge. I understand that to seek to gain an advantage through providing false information is
liable to action being taken under the Regulations Governing Academic Misconduct.

Student Signature Date 03 Sep 2018

PART 6 – (Completed by University of Hull Staff)

DECISION ON COURSEWORK EXTENSION REQUEST

Extension Request Accepted New deadline date

Extension Request NOT Accepted Reasons

IMPORTANT INFORMATION
If your course work extension has not been accepted, you must submit your
coursework by the original deadline date. Late work is subject to penalties and any
work not submitted will be awarded a mark of zero which could mean that you fail the
module. If you believe that the difficulties you are experiencing may mean that you
cannot submit your work, you may need to consider submitting Mitigating
Circumstances.