R30 Form Faculty of Science and Health_��

Extenuating Circumstances Form (R30)

Student Steps to submit Extenuating Circumstances (R30)

1) Gather relevant supporting documentation for your personal circumstances.

2) Fill out the "Application of Extenuating Circumstances (R30 process)" detailing the reason for your application.

3) Once you have the following to hand you may proceed to fill in the below webform.

Application of Extenuating Circumstances (R30 process)
Supporting documentation.

4) Follow the steps on the Submission portal. Once you upload your documentation and press submit, you will receive a submission confirmation to your DCU email account.

Data Privacy Notice

The personal data (including any special or sensitive data) requested on this form will be obtained, processed and retained by DCU (the Data Controller). The data is required to assess your request and will be processed by relevant units within the University. The data will be retained for eight years at end of which it will be erased. Please refer to the University's Data Privacy Policy for further details. If you wish to obtain further information about data protection please visit the website of the Irish Data Protection Commissioner.
Note: The processing of special categories of personal data collected on this form and described above will be based on your consent.

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Student ID number (as per your student ID card)

First name

Surname

DCU email address

Programme of study/Qual Code (as per your Student ID card)

Year of study

Details of Examinations/Assessments Affected. To add more modules please click on the 'Add' button.

Module Code	Module Title	Operations
Module Code	Module Title

more items

	Please select the semester(s) affected by your extenuating circumstance(s)
	Semester 1 September to December
	Semester 2 January to April
	Resits July/August

Period affected from

Period affected to

Please note

If you have selected more than one period above, your supporting documentation should cover this period. Registry may contact you to confirm that your supporting documentation is up to date in advance of the resit period. It is the your responsibility to make sure that accurate supporting documentation is submitted to Registry within the published deadlines.

	Please tick the box below which best describes your extenuating circumstances
	Illness, injury, accident or hospitalisation.
	Family illness
	Bereavement
	Other personal or emotional circumstances
	Victim of crime
	Work commitments (Part-time students only)
	Other

Application of Extenuating Circumstances (R30 process)

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Supporting Documentation

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I confirm that the information given in this form is true and factually correct. I understand that this information may be disclosed, where absolutely necessary, to academic and administrative staff of the University directly involved. I also consent to the processing of the special categories of personal data provided on this form for the purposes described in the Data Privacy Notice above.

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