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Appendix Appendix 1* Personal Circumstances Form PERSONAL CI RCUMSIANCES FORM STUDENT DEI'AILSStudent Name Student lD lntake Programme Faculty Contact no. CIRCUMSTANCES AND THEIR IMPACTPlease describe your personal circumstances.o All personal circumstances applications MUST be accompanied by supportingevidence e.g. a medical certificate. 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Please provide the module code, module name, type of assessment and date for eachassessment you are applying for. Module Code Module Name Assessment Type Assessment Date Tick ifattempted DECLARATION I declare that the information above is true, that any supporting evidence provided is genuineand that the college reserves the right to request to see a physical copy of any originalsupporting evidence and that failing to do so may impact on the review of my personalcircumstance claim. 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