The QAA Access to HE Diploma
(The Diploma)
Aegrotat Award Application Form / /

1. Please discuss your application with the Head of Access at One Awards before completing this form

2. Refer to the guidance in the Access to HE Provider Handbook for Applications for Aegrotat Awards when completing this form

3. All applications must be received at least two weeks prior to the Final Award Meeting*

4. The final decision on the application will be made by the Access to Higher Education Committeeat its meeting in July.

* Applications arising after this deadline must be discussed with One Awards who will advise on theprocedure to be followed.

PROGRAMME TITLE:

STUDENT NAME:

STUDENT DATE OF BIRTH:

A)TUTOR’S STATEMENT - Please describe the relevant exceptional, extenuating, certificated

medical circumstances, the supporting evidence available (attach evidence referred to) and the

reasons why the student cannot complete a component(s) of the assessment requirements.

I confirm that the details recorded above are truthful and accurate.

Tutor’s Signature ...... Date ......

B)ACHIEVEMENT

1) Please give details of the Units/Other requirements which the student has not achieved.

2) Describe evidence of partial achievement available for the non-completed units.

3) Please list the units completed (The student must have achieved at least 30 of the credits required for The Diploma)

C)SUPPORTING STATEMENT FROM PROVIDER - Please explain why you are supporting thisapplication, comment specifically on the student’s potential to succeed in HE, and list the evidencethat has been verified that is attached to the form.

Signature ......

(Senior Manager with responsibility for the Access to HE Diploma)

Print Name ...... Date ......

D)RECOMMENDATION OF LEAD MODERATOR - please identify whether or not you

recommend the student be awarded the Access to HE Diploma – Aegrotat Award.

I support this application:YES/NO

COMMENTS:

Signed: ………………………………………. (Lead Access Moderator) Date:………………

Print name:

All applications for Aegrotat Awards will be reported to the Awards Board by the Lead Moderator,along with their recommendation to the One Awards Access to HE Committee. The Access Committee meets in the 3rd week of July and notification of the Committee’s approval decision will be forwarded to the provider within 1 working day of the meeting.

Version 2.0 / Page 1 of 3
Original created:02 August 2017 / Last edited:30 July 2018 / Due for review: August 2019
The QAA Access to HE Diploma (The Diploma), Aegrotat Award Application Form