Forms

Request for Deferred Exam

NEW: Supporting documentation can now be attached to this form. Upon submission of the form, you will be asked to attach your documentation.

There is a fee of $65 for each deferred exam. This fee is charged to your MUN account if your request is approved. Requests for deferred exams, including supporting documentation, must be submitted no later than seven days after the date on which the exam was scheduled. Document must be received before your request can be considered. Documentation may be faxed to (709) 864-4070. Note: If your request is due to having three exams in one 24-hour period, please list all courses and their corresponding dates and times. You will be contacted by email when your application has been processed.

Student Number

First Name

Last Name

Phone Number

To comply with Memorial's single email policy, DELTS uses @mun email addresses to communicate with students whenever possible. Please check your @mun email address regularly to ensure you receive all important communication from our department. We encourage you to use your @mun email address when completing this form.

Email Address

Exam Site for Deferred Exam(s)

Course Number One

Course

CRN

Instructor

Exam (Midterm, Test, Final, etc.)

Date and Time of Scheduled Exam

Reason for requesting deferred exam

Course Number Two

Course

CRN

Instructor

Exam (Midterm, Test, Final, etc.)

Date and Time of Scheduled Exam

Reason for requesting deferred exam

Course Number Three

Course

CRN

Instructor

Exam (Midterm, Test, Final, etc.)

Date and Time of Scheduled Exam

Reason for requesting deferred exam

Course Number Four

Course

CRN

Instructor

Exam (Midterm, Test, Final, etc.)

Date and Time of Scheduled Exam

Reason for requesting deferred exam

Information Required for Medical Certificates

Students who request permission to drop courses, to withdraw from University studies, to have examinations deferred or to obtain other waivers of University, departmental or course regulations based on medical grounds are required by the University to produce a note from a physician in support of their request. Such notes must be sufficiently specific to allow a proper consideration of the student's case. The University requires that all medical notes must be on letterhead, must be signed by the physician, must confirm the specific dates on which the student visited the physician and should include details on the following:

the degree to which the illness (or treatment, in the case of medication, for example) is likely to have affected the student's ability to study, attend classes, or sit examinations.
the length of time over which the student's abilities were likely hampered by the medical condition (e.g., recurring and severe back pain over a two-month period would likely have a more adverse effect on studies than a single episode of back pain requiring bed rest for a week).
the fitness of the student to resume studies (it is in the student's best interest not to return to studies prematurely).

Confidentiality: The University respects the confidentiality of all material contained in medical notes. Physicians are strongly advised to retain a copy of the medical note in case the medical note needs to be verified or reissued at a later date.

NOTICE

"Memorial University protects your privacy and maintains the confidentiality of your personal information. The information requested in this form is collected under the authority of the Memorial University Act (RSNL 1990 Chapter M-7) and is used for the purposes of academic and student services administration. Questions about the collection and use of this information may be directed to the Services Coordinator at 709-864-3532."