Request for Consideration of Extenuating Circumstances

Request for Consideration of Extenuating Circumstances
Current Year:*

Year 1Year 2
Name*

First NamePreferred NameLast Name
Student Number or Application Number*
Please enter a value between 1 and 9999999999.
Email*

Confirmation EmailPlease enter an e-mail address where a confirmation of receipt can be sent to you.
At this time, we ask that any student with an extenuating circumstance they would like considered during the placement planning process to detail the circumstance in the space provided below.*

** Extenuating circumstances are defined as personal situations related to family care responsibilities or to current clinical accommodations as recommended by Accessibility Services only.0/1000
In addition, if you have made prior clinical arrangements with the Director of the Program, Heather Thomson, in relation to a personal circumstance, please describe those arrangements on the form as a reminder.
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