STUDENT SELFCERTIFICATION OF ILLNESS PLEASE READ THE UNIVERSITY’S GUIDANCE

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Student Self-Certification of Illness

Student Self-Certification of Illness

Please read the University’s Guidance for Students on Extenuating Circumstances before completing this form.

This form should be used to self-certify the first 7 days of any period of illness, for which you do not need to submit a medical certificate/doctor’s note.

For the first 7 days of an illness, your self-certification will have equal status to a doctor’s note.

If your illness lasted/has lasted for more than 7 days, please provide a doctor’s note in addition to this certificate.

This certificate should be completed by you and must accompany your Extenuating Circumstances claim in all cases where you are claiming illness. You should upload the self certificate into the eVision Extenuating Circumstances task no later than five working days after the assessment deadline or exam or other assessment event.

NAME:
STUDENT ID:
DATE ILLNESS COMMENCED:
DATE ILLNESS ENDED (if it has ended):
DATE OF DOCTOR’S NOTE (if applicable):

DETAILS OF ILLNESS (please continue overleaf if necessary):

DECLARATION

I declare that the above information is true and accurate to the best of my knowledge. I understand that to give false information could result in the University taking action against me for misconduct in accordance with Senate Regulation 6.

SIGNED:

DATE:

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