QMU Deferral Request Form - Queen Margaret University

Queen Margaret University
Student Deferral Request Form
The data you provide will be processed in accordance with the QMU Data Protection Policy
available at http://www.qmu.ac.uk/foi/dp.htm.
You should refer to the Student Deferral Procedure, available at
http://www.qmu.ac.uk/thinkingofleaving/break.htm before completing this form.
The form should be typed and submitted electronically to [email protected]
Please note:
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Students must discuss their application with their Programme Leader and make supporting
documentary evidence available to them before submitting the form. These documents do
not need to be submitted with this request form but the Programme Leader must be able to
confirm that they have seen them.
International students studying on a Tier 4 student visa must also seek advice from the
International Student Support Coordinator (email [email protected]) before completing this
form. Any period of deferral will affect your Tier 4 student visa status.
There may be changes to your programme during an approved period of deferral.
A deferral of studies will normally be granted for a maximum of 12 months.
Section A – To be completed by the student
1. YOUR PERSONAL DETAILS
Full Name
QMU student
number
Current level of
study
Mode of
attendance
L1
Full time
L2
L3
L4
Postgraduate
Part time
Programme
Date of last
attendance
2. REASON FOR DEFERRAL
Main reason for
deferral
Employment
Financial
Health
Personal
Please provide details of your reasons for requesting a deferral in the box below.
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DEFERRAL REQUEST FORM
3. PROPOSED DURATION OF DEFERRAL
Please note that the maximum period of deferral allowed is 12 months only.
Start date
Month:
Year:
End date
Month:
Year:
Total duration
months
4. I confirm that I have discussed my request for deferral with my Programme Leader.
SIGNATURE*
DATE
*Please type your name above. The University will consider the receipt of this form electronically,
from your QMU student email, as being equivalent to a signature. Any email correspondence
about your request will be sent to your QMU student email account.
Please submit the completed form by email to [email protected]
Or click here to submit your form directly to Thinking of Leaving
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DEFERRAL REQUEST FORM
Section B - To be completed by the Programme Leader
This form should be typed and submitted electronically to [email protected]
1. PROGRAMME
LEADER’S NAME
2. DO YOU APPROVE THE STUDENT’S REQUEST TO DEFER THEIR STUDIES?
Please confirm if you approve the student’s request and if you have seen any documentary
evidence which supports their request. If you do not approve the request please outline the
reasons for this.
Approved
Yes
Supporting documentary evidence seen
Yes
No
Date:
Provide brief rationale in the box below if request is not approved.
3. CONDITIONS OF DEFERRAL AND RETURN DATE
Specify any special conditions of the deferral e.g. forthcoming changes to the programme which
may impact on the student when they resume studies. For Health Sciences students with
mandatory placements please outline any impact on clinical hours and how this will be addressed
on return to studies.
Deferrals are normally granted for a maximum period of 12 months.
If the student has deferred for medical reasons state if they will need to provide evidence of
fitness to study before their return to the programme.
Special conditions
(if applicable)
Agreed return date
Medical evidence
required on return
Month:
Yes
Year:
No
4. SIGNATURE*
DATE
Save and email the completed form or click here to submit it directly to Thinking of Leaving
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DEFERRAL REQUEST FORM
*Please type your name above. We will consider the receipt of this form electronically, direct from
you, as being equivalent to a signature.
The Thinking of Leaving Team will notify the student of the outcome of this request. A copy of the
form will be sent to the School Office, Registry and any other relevant department e.g.
Accommodation or RILO, to ensure that the student’s record is updated.
For use by the Thinking of Leaving team
Sent to Programme Leader
Returned to TOL by Programme
Leader
Student notified of outcome
School Office notified of outcome
Other relevant departments notified
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