PREP Capstone Notice of Emergency Circumstances

Students submitting this form should ensure they have read and understood CPLED’s policies.

This form should be used by students to notify CPLED of extenuating circumstances that have arisen immediately prior to or during the Capstone Evaluation and to request a specific remedy from CPLED in this regard.

CPLED generally considers extenuating circumstances to include medical emergencies, the birth or death of an immediate family member, natural disasters, personal legal obligations, severe personal or family crisis, or other grounds protected under applicable Human Rights law.

CPLED does not generally consider extenuating circumstances to include minor illnesses, common ailments, workload from school or employment, scheduling conflicts, vacations, transportation problems, or technical issues.

Submission of this form does not guarantee any remedy from CPLED. Upon review, CPLED will consider extenuating circumstances on a case-by-case basis to determine any available remedies.

Name(Required)

First Last

CPLED Student ID Number(Required)

Find your ID Number in the Student Portal under “MENU”.

Email(Required)

Phone number(Required)

Please provide a detailed explanation of your extenuating circumstances, including how these circumstances impact your Capstone Evaluation performance.(Required)

What remedy are you seeking from CPLED in response to your extenuating circumstances? Please be as specific as possible.

Are you including supporting documentation with your request?(Required)

CPLED generally requires supporting documentation to consider extenuating circumstances requests. This should be clear, evidence-based documentation that supports the rationale for your requested remedy. The date range of the supporting documentation must substantiate the date range of the request.

Yes

Supporting documentation

Please note that you can redact personal and confidential information. Examples of appropriate supporting documentation: hospital records, court or police documents, or death notices. (choose file)

Max. file size: 200 MB.

I confirm that I have read and understood the requirements of this form and any relevant CPLED policies. I affirm that all the information and documentation provided in support of this application are accurate and true. I understand that CPLED may request further information and documentation from me in support of my application. For the purposes of verifying authenticity, I authorize CPLED to contact anyone who provided documentation submitted in support of this application, including but not limited to medical documentation.(Required)

First & Last Name