School of Maths Mitigating Circumstances Form V2
 
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 General Information  

 
1.
*
 
   
2.
*
 
   
3.
*
 
   
4.
* (99999999)
This can be found on your student card.
 
   
5.
*
 
   
6.
*
 
   
7.
*
 
   
8.
*
 

    
   
9.
*
If you need more space to further describe your circumstances, hand in an additional letter with your documentary evidence. Please do not enter more than 100 words.
 
   
10.
*
  Select Date
dd/mm/yyyy
   
11.
Please leave blank if this is an ongoing condition and select Yes in the next question.
  Select Date
dd/mm/yyyy
   
12.
Or is this an ongoing condition?*
 
   
 
 
 
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