Section 1	Student to Complete

Student’s Name:	Student’s ID No:

Programme:	Year:

Course:	Level:	Credits:

Request for a Restricted Pass (Academic Statute 7.4.1.1):

In Exceptional Circumstances, the Faculty Board of Studies may, at its discretion, grant a “Restricted Pass” (R) for the final result in a course. A Restricted Pass is defined as one awarded where the student has marginally failed to meet the required assessment standard for the course and one which, when awarded, does not qualify a student to enrol in a subsequent course/programme for which a pass in the original course is a pre-requisite.

Section 2	Programme Leader’s recommendation

A request for a Restricted Pass must be given careful consideration. Please provide a brief rationale for your recommendation.

In order for a Restricted Pass to be considered, the Programme Leader or equivalent is required to submit information on the student’s achievement in the course in question.

Student achievement information in Section 3 completed?	Yes	No

Is this paper a pre-requisite for others?	Yes	No

Programme Leader:	Date:

Restricted Pass Approved

Chairperson, Board of Studies:	Date:

Section 3	Student achievement in the paper:

Paper Number	Paper Title	Assessment 1	Assessment 2	Assessment 3	Final Grade