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PGT Mitigating Circumstances Online Declaration Form

This form is only for use by student's registered on either the following iheed courses:

  • MSc in Diabetes Care (Including Certificates and Diplomas)
  • MSc in Medical Education for Health Care Professionals (Including Certificates and Diplomas)
  • Public Health and Health Promotion (Including Certificates and Diplomas)

The form should be completed if you want to make the University aware of any mitigating circumstances which you believe may have adversely affected your performance either during the year or in relation to one or more module assessment. Please read the University Mitigating Circumstances guidance before completing the sections which apply to you.

Upcoming Deadlines: 

Monday 20th of June 2022 iheed MC (Public Health)

Friday 26th of August 2022 Iheed MC (Diabetes)

Friday 26th of August 2022 Iheed MC (Medical Education)

All cases must be submitted by the above deadlines for consideration ahead of the Summer Board of Examiners meeting. Forms will not be accepted after the deadlines stated.

Please state the type of mitigation you are presenting (you may select more than one type and if other please provide details): (required)
Please state the length of time/period affected (giving dates), and details of any assessments affected (timeliness):
Please indicate who you have contacted in relation to your mitigating circumstances (please select more than one option if applicable) (required)
Have you been granted an extension or taken Temporary Withdrawal (TWD) for this Mitigating Circumstance already (required)
PART TIME STUDENTS ONLY Have you been granted sick leave from work for this Mitigating Circumstance (required)
Attach file
No files are currently attached.
Please indicate which exam board recommendation you are seeking through this claim: (required)
By submitting this form you are confirming that the information you have given is true and that you have read and understood the University Guidance on mitigating circumstances.
Privacy notice
Please note that the information you provide will be reviewed by the departmental mitigating circumstances pre-board in order to make a recommendation to the Board of Examiners about your case. The University will keep your full student record for six years after the end of the academic year in which you graduate from, other otherwise leave the University. After six years, the University will retain only the data necessary to identify you and confirm the dates you studied at the University, the degree and classification you were awarded and a transcript of your marks. All other personal data on your student record will be disposed of in a secure manner.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at