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Faculty of Science Missed Term Work Form.
To be submitted by students enrolled in courses at the Faculty of Science for all:

Midterm Exams, Quizzes, Assignments, or Term Work (including lab work).
For information regarding interruptions to your studies, please visit the Course
Interruptions page. To request deferral of Registrar-scheduled FINAL exam(s)
follow the process determined by the UCalgary Registrar's Office (linked here).
Important information:
• Please submit one form for each missed assessment.
• If you have already completed a midterm exam, quiz, or assignment, you may
not retroactively request an alternative arrangement for that assessment.
• For religious observances, you must submit this application a minimum of 14
days ahead of the assessment or the request will be denied.
• For Dino student-athletes attending games, tournaments, or other mandatory
team events, you will be required to fill out the form.
• For alternative arrangement requests due to illness or emergency, you must
submit your request with information and/or supporting documentation as soon as
possible.
• All regularly scheduled classes/tutorials/labs take precedence over out-of-class
midterms.
Form submission:
Once you have successfully completed this form, you will have the option to
download a PDF copy of your submission. If you are not given this option, it
means that you have not successfully submitted your form.
Please download the .pdf of your response and keep it for your records. You will
be notified by your instructor of the status of your request via email, typically within
5 business days.
Student Preferred First Name
Vaishnavi
Student Last name:
Gupta
UCID number:
30244463
Student UCalgary email address (name@ucalgary.ca):

Will be used to send a completed copy of this form
vaishnavi.gupta1@ucalgary.ca
Class:
MATH
Course Number: (eg. 317)
211
Section or lecture:
05
Instructor's First Name
Adel
Instructor's Last Name
Mohammadpour
Instructor's Email
Must be accurate. Will prompt instructor that a request has been submitted.
adel.mohammadpour@ucalgary.ca
This deferral request is for:
Midterm exam
Quiz
Assignment
Other Term Work (please specify)
Are you currently enrolled in the Academic Turnaround Program (ATP)?
Yes
No
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What Faculty are you currently enrolled in?
Faculty of Science
Other Faculty (please specify)
Schulich School of Engineering
What is the reason for this missed term work?
Health Condition or Injury

Domestic Affliction
Bereavement
Religious/ Spiritual Observance Including Oral Invitations from Elders or
Traditional Knowledge Keepers
Participation in University Athletic/ Scholastic Event
Other (please specify)
Is the assessment for which you are requesting a deferral:
Within the next 48 hours

Within the past 48 hours
More than 48 hours ago
More than 48 hours from now
Date of assessment for which you are requesting a deferral (mm/dd/yyyy)
10/29/2024
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Please explain why you missed the assessment:
I vomited during the test due to migraine issues, and had to hand in the exam and request
it be cancelled and deferred. I take Almotripton and Zofran for my migraines, one
medication is for the headache itself and the other is for nausea but it makes me very
drowsy and when I get migraines I vomit often. I did take these medications before the
exam but they do take time to take effect so it did hinder my ability to the test.
Characters remaining: 1072
Supporting Documentation
In accordance with section G.2.3 of the Academic Calendar, a course instructor

may ask for supporting documentation to confirm an absence. As per section M.1
of the Academic Calendar. Please see your course outline for information on
whether supporting documentation is requested by your instructor for an approved
absence.
a. A student cannot be required to provide a specific type of documentation.
b. The decision to provide supporting documentation that best suits the situation is
at the discretion of the student.
c. Medical documentation is not required and cannot be requested as a form of

documentation from a student; however a student may choose to provide it.
Supporting documentation must clearly demonstrate serious illness or

extraordinary circumstance beyond the student’s control that would warrant
deferral of assessment. You decide what supporting documentation is most
appropriate to share with your course instructor to support your request for an
alternate arrangement. The course instructor will confirm if an alternate
arrangement is possible. Should you choose to use supporting documentation in
support of your deferral request, please submit a copy of the document below.
Please note, that only one document can be uploaded. Acceptable file
formats include .doc, .docx, .pdf, .png, .jpg. .jpeg, .txt. .xls. .xlxs
If you are not submitting supporting documentation, please click “next” below.
For information regarding interruptions to your studies, please visit the Course
Interruptions page.
Drop files or click here to upload
Did you submit supporting documentation?
Yes
No
Page 3 of 4
Personal and privacy information
All documents submitted by students will be kept in accordance with university

records retention rule 99.0006 Student Academic Files – Undergraduate and
98.0018 Student Academic Files – Graduate.
Collection of Personal Information
Your personal information is collected under the authority of section 33(c) of the
Freedom of Information and Protection of Privacy Act. If you have any questions
about the collection or use of this information, please visit our Access to
Information page. The documentation submitted will be used to inform the decision
regarding the request for deferral. All documents will be handled as per the
guidelines above. Access to information collected through this form will be limited
to a select group of individuals involved in the administration of deferral requests
in the Faculty of Science. Your personal information will not be disclosed or used
for any purpose that has not been stated above without your direct consent.
I understand that submission of this information is not an exemption from the
assessment that was missed, or will be missed, and that approval for the deferral
will be at the discretion of the instructor of the course.
Yes
I understand that submitting false information or falsifying documentation will be

taken very seriously, and may result in disciplinary action through the student non-
academic misconduct policy.
https://www.ucalgary.ca/student-services/student-conduct
Yes
Declaration:
I confirm that the information I have provided is true, complete, and

accurate. (Use your mouse or finger to sign)
×
clear
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We thank you for your time spent taking this survey.

Your response has been recorded.

To be submitted by students enrolled in courses at the Faculty of Science for all:

Student Last name:

Student UCalgary email address (name@ucalgary.ca):

Course Number: (eg. 317)

Instructor's Last Name

This deferral request is for:

Are you currently enrolled in the Academic Turnaround Program (ATP)?

What is the reason for this missed term work?

Health Condition or Injury

Is the assessment for which you are requesting a deferral:

Within the next 48 hours

Date of assessment for which you are requesting a deferral (mm/dd/yyyy)

In accordance with section G.2.3 of the Academic Calendar, a course instructor

a. A student cannot be required to provide a specific type of documentation.

c. Medical documentation is not required and cannot be requested as a form of

Supporting documentation must clearly demonstrate serious illness or

Did you submit supporting documentation?

Personal and privacy information

All documents submitted by students will be kept in accordance with university

Collection of Personal Information

I understand that submitting false information or falsifying documentation will be

I confirm that the information I have provided is true, complete, and

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