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Student Special Consideration Form

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STUDENT SPECIAL CONSIDERATION FORM

Use this form to request special consideration for assessment, examination, or other academic requirements where circumstances beyond your control have adversely affected your ability to meet academic obligations. Submission of this form permits the institution to review the request, verify supporting documentation and make determinations in accordance with academic policy. Provision of false or misleading information may constitute academic misconduct and may be subject to disciplinary action.

Student Information

Date of Birth:

Enrolment status:

Request Details

Type of consideration requested (tick all that apply):






Assessment / Event name:

Scheduled date of assessment:

Original due date / submission date:

Reasons and Supporting Evidence

Select primary reason(s) for request:









Privacy, Verification and Process

By submitting this form you consent to the institution verifying the information and supporting documentation with relevant third parties where necessary (for example, medical practitioners or service providers). The institution will manage personal information in accordance with applicable privacy and student records policies. Processing of this request may require additional information; failure to provide requested information may result in refusal of the application.

Decisions: Applications will be assessed against the academic special consideration criteria. Possible outcomes include approval of an extension, deferred assessment, alternative assessment, requirements for further evidence, or refusal. A decision will be communicated in writing within a reasonable timeframe. If approved, the approved arrangement will be recorded and notified to relevant teaching staff.

Declaration

I declare that the information provided in this form is true and complete to the best of my knowledge. I understand that submission of this form does not guarantee approval and that knowingly providing false information may lead to academic misconduct procedures. I authorise the institution to contact third parties to verify supporting documentary evidence where necessary.

Applicant is under 18 years of age:

If applicant is under 18, Parent/Guardian name and contact (for administration use):

Print Name:

Signature:

Date:

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What the Student Special Consideration Form Is

Student Special Consideration Form is an institutional administrative document used by colleges and universities to request adjustments, accommodations, or review of assessment outcomes when a student's performance is affected by exceptional circumstances. Typical uses include illness, bereavement, personal emergency, disability impacts, or documented disruptions during assessment periods. The form records the student's details, course and assessment identifiers, a clear description of the event, dates, and supporting evidence. Institutions use submitted forms to determine outcomes such as deferred assessment, alternative assessment formats, extensions, grading adjustments, or formal appeals under academic regulations.

Why a Formal Consideration Form Matters

Using a Student Special Consideration Form creates a documented, auditable basis for fair academic decisions, ensures consistent treatment under institutional policy, and preserves evidence for appeals. It helps administrators evaluate accommodation requests efficiently while protecting student privacy under FERPA and, where health data apply, HIPAA considerations.

Why a Formal Consideration Form Matters

Who Uses the Form and How It Fits into Campus Roles

Campus staff, instructors, disability services, and students commonly interact with this form during assessment-related exceptions and accommodation reviews.

  • Students — request extensions, deferred assessment, or reconsideration with supporting documentation.
  • Academic advisors — help prepare submissions and verify eligibility under institutional rules.
  • Disability services — assess accommodation needs, manage supporting medical documentation and formal plans.

Institutions and review panels rely on consistent form completion to ensure equitable case handling and defensible decisions in academic records.

Simple Step Sequence to Complete and Submit the Form

Follow this step sequence to complete and submit the Student Special Consideration Form accurately on time.

  • 01
    Gather details: Collect course, assessment, dates, and evidence.
  • 02
    Attach evidence: Upload medical notes, reports, or other supporting files.
  • 03
    Provide statement: Write a concise description of circumstances and impact.
  • 04
    Sign and submit: Sign electronically or physically, then submit to specified office.

Where Completed Forms Are Sent and How They Move

This section explains where to send completed forms and how institutional routing typically proceeds internally.

  • Submit to office: Send to student services or faculty office listed on the form.
  • Online portal: Upload via the institution's student portal or records system.
  • Email submission: As permitted, email signed PDF to the designated administrative address.
  • In-person delivery: Deliver originals to the registrar or authorized campus office.

File Formats, Authentication, and Privacy for Electronic Submissions

Electronic submission and eSigning require compatible file formats, signer authentication, and privacy protections aligned with FERPA and institutional policy.

  • Supported formats: PDF, DOCX, or scanned images.
  • Authentication options: Email link, SMS code, or institutional SSO.
  • Privacy safeguards: FERPA compliance; HIPAA BAA where health data.

Typical Deadlines and Submission Windows to Note

Key deadlines vary by institution; check local policy for submission windows, evidence timelines, and appeal periods.

Notify instructor or review office promptly:

Within 24–72 hours of incident when feasible.

Submit form within institutional window:

Commonly within 5–10 business days of assessment.

Deadline for submitting supporting evidence varies:

Upload or attach documents specified in policy within stated timeframes.

Appeal lodgement period after decision issued:

Follow appeals policy; typical range 5–20 business days for lodgment.

Record retention and audit timeline:

Keep copies per institutional retention schedule for audits or appeals.

Common Preparation Errors to Avoid

  • Incomplete or vague incident descriptions cause delays; reviewers often request clarifying information which extends processing times and may miss deadline windows.
  • Attaching illegible scans or wrong document types leads to rejection; always upload clear PDFs or properly labeled images to prevent resubmission.
  • Using informal email explanations instead of the formal form undermines standard procedures and can result in inconsistent treatment across cases.
  • Failing to obtain required signatures, witness statements, or supporting medical notes frequently invalidates requests and forces applicants to restart the process.

Consequences and Administrative Risks of Incorrect Submissions

Missed deadlines: Request denied; no retroactive adjustment.
Incomplete evidence: Delay or rejection until documents provided.
Incorrect signer: Invalid authorization; may require re-signature.
Privacy breaches: FERPA or HIPAA violations risk sanctions.
Appeal limits: Limited grounds once decision finalized.
Recordkeeping gaps: Compliance failures for audits or appeals.

Security and Legal Frameworks That Apply

FERPA: Protects student education records privacy.
HIPAA: Applies to health information; BAA required.
ESIGN / UETA: Validates electronic signatures in most transactions.
Encryption: TLS in transit; AES-256 at rest.
Audit trail: Timestamps, IP, and action history retained.
Access controls: Role-based access and multi-factor authentication available.

Key Elements a Professional Form Should Include

A professional Student Special Consideration Form combines clear applicant data, incident chronology, necessary attachments, and institutional decision fields to speed review and preserve an auditable record.

Student information

Includes full legal name, student ID, contact details, program, and enrollment status; accuracy ensures staff can retrieve academic records and correlate the request to the correct assessment.

Incident summary

A clear, chronological account specifying dates, times, and how the incident affected performance; avoid overly emotive language and include only relevant factual details for reviewers.

Supporting documents

Attach medical certificates, counselor letters, or official reports; indicate document dates and signers. Unauthenticated or undated documents are less persuasive and may be disregarded.

Requested outcome

Specify the remedy sought (extension, deferred assessment, special exam arrangements, or grading consideration) and provide rationale linking the incident to academic impact with any policy citations.

Academic office use

Include fields for reviewer notes, decision codes, authorizing signatures, and date of decision to create a permanent administrative record for audits and potential appeals as required.

Privacy statement

Provide a notice on how submitted information will be used, retained, and shared; reference FERPA and, if health data included, that HIPAA safeguards apply and a BAA may be required.

Realistic Examples of How the Form Is Used

These examples show realistic, anonymized scenarios where a Student Special Consideration Form resolves assessment disruptions.

Illness case

A third-year student missed a major exam due to sudden hospitalization and could not submit prior notice because of emergency room care.

  • Submitted medical record and discharge summary.
  • Review panel accepted the evidence, granted a deferred exam date, and recorded the decision in the student's file, allowing fair reassessment while preserving the institution's audit trail and appeal rights.

Bereavement case

A student experienced the death of an immediate family member one week before final assessments and requested short-term deadline extensions for multiple assignments.

  • Provided obituary and funeral program.
  • The department approved staggered deadlines, recorded accommodations, and provided instructions for incomplete grading while advising on supplemental submission procedures and appeal options.

Starting Price and Feature Snapshot for Common eSignature Vendors

Pricing and feature availability vary by plan; below is a high-level starting-price and feature comparison across leading eSignature vendors.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial Yes, 7-day trial Varies Varies Varies Varies
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No

FAQs: Common Questions About the Student Special Consideration Form

Answers to frequent questions about completing, submitting, and electronically signing the Student Special Consideration Form, including privacy and legal validity.


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