ࡱ>  0 bjbjss 8r228T,,J+X(( " " "*******$,/* "z " " "**D$$$ "p*$ "*$$'(GRr|"F'{*+<J+',f0"f0(f0(x " "$ " " " " "**# " " "J+ " " " "f0 " " " " " " " " "2 R: APPLICATION FOR FLEXIBLE ASSESSMENT APPROVAL Academic Registry Student Records and Examinations Office HYPERLINK "http://www.google.co.uk/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiagKSqtN7MAhUDIcAKHdLkBDAQjRwIBw&url=http%3A%2F%2Fdanleedham.com%2F2015%2F10%2Floughborough-university-high-resolution-new-logo%2F&psig=AFQjCNE-D7SPkb6AnAC7z0IgdoFNLBJP1g&ust=1463481695960535"  INCLUDEPICTURE "http://danleedham.com/danleedham/wordpress/wp-content/uploads/2014/12/Ƶ-Univeristy-Lboro-Logo.png" \* MERGEFORMATINET This form is for flexible assessments due to competition at major international sporting events only. Please complete in conjunction with the Assessment Flexibility Policy. If it relates to examination flexibility it should be returned to Student Records & Examinations Office. If it relates to coursework flexibility a copy should be retained by both the Academic School and the Sports Development Centre. Part One To be completed by the Student1. Name2. ID Number3. Email Address4. Department5. Current Programme6. Year of Study7. Assessment Flexibility requested (please tick the appropriate box)a) Examination Flexibility (b) Coursework Flexibility (8. Please provide details of the competition or event which clashes with your assessment Sport: Dates Away: (complete date including travel time) Level of Competition: Location: Additional Information: 9. NGB Supporting Statement Please tick to confirm the NGB supporting statement is attached to this form(10. STUDENT DECLARATION I confirm that the above information is correct and fully understand the implications of assessment flexibility. I understand that participation in an international sporting event is completely my own choice and that flexible assessment arrangements alone will not normally be sufficient grounds for a claim for impaired performance at a later date. I understand that if I defer the first attempt of my examinations to the SAP and subsequently fail any of those examinations, there will be no opportunity to retake those examinations before the next academic year. This will have implications relating to the continuation on to the next stage of my course and could mean that my graduation takes place later than for the majority of my cohort. I understand that flexible assessment is a privilege and not a right and that the final decision rests with my academic department. Signature: Date: / /  Part Two To be completed by the Sports Development Centre11. The Sports Development Centre DOES / DOES NOT support this REQUEST (please circle as appropriate) Please note this is a request; the final decision remains with the academic department.12. To be completed by the University Head Coach for your Sport (Not required if NGB supported statement and Performance Director or nominee supporting statement included) Please provide comments/reasons for support of this application: 13. UNIVERSITY HEAD COACH DECLARATION I confirm that the above information is correct and that I have fully discussed the implications of assessment flexibility with the student Print Name: Signature: Date: / /  14. To be completed by the Performance Director of Sport (or nominee) Please provide comments/reasons for support of this application: 15. Proposed flexibility option in line with what the SDC can facilitate: Module Code Module Name Proposed Alternative A) B) C) D) 16. DECLARATION by ...(insert job title) I confirm that the above information is correct and that I have fully discussed the implications of assessment flexibility with the student and their coach Print Name: Signature: Date: / /  Part Three To be completed by the Academic School17. The School of DOES / DOES NOT support this application (please circle as appropriate)18. To be completed by the Students Director or Studies or Programme Director (or Nominee) Please provide comments / reasons for support of this application: 19. Agreed schedule of flexible assessments recommended by the School: Year 20_ _ -20_ _Module CodeModule NameModule School (for students taking modules outside their own School)Assessment Type (Exam/ Coursework)Scheduled DateAgreed Alternative Arrangements (1) SAP (2)Exam in situ (3)coursework flexibilityA)B)C)D)20. Approval for out-of-school modules (if applicable) I confirm on behalf of the _____________________ department that we support this application for academic flexibility. Print Name: Signature: Date: / /21. DIRECTOR OF STUDIES OR PROGRAMME DIRECTOR DECLARATION (or nominee) I confirm that the above information is correct and that I have fully discussed the implications of assessment flexibility with the student Print Name: Signature: Date: / /  Exam Flexibility: Once this form has been completed please return to Student Records to allow the student record to be updated. Student Records to send a PDF copy to Simon Wombwell (S.L.R.Wombwell@lboro.ac.uk) once finalised. Coursework Flexibility: Once this form is completed a copy should be returned to SDC (Simon Wombwell, Education and Development Manager, SDC), and one kept within the Department. 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