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Uw gegevens

Name *

Phone number *

RU email address *

Studentnumber *

Study *

Bachelor PPS (180 EC)

Masters specialisation Theology (60 EC)

Master Theology (180 EC)

Research master Philosophy (120 EC)

Ground

I hereby request the Examining Board to grant an extra examination based on the following EER-article(s) *: *

Ground: *

Request for extra examination

Request for an extra examination (please state course code and course name) *

Level: *

Bachelor 1

Bachelor 2

Bachelor 3

Master

Lecturer: *

First two examination opportunities

Date of first exam *

Result: *

Date of second exam: *

Result: *

I was unable to attend the first or second exam opportunity *

Yes

No

I have reported my absention: *

Yes, at the student administration

Yes, at the lecturer

No, I didn't report it

Not applicable

Attachment

If applicable please attach here,

Attachment

Remarks/questions

Additional remarks/questions *

Statement

I herewith declare to have filled in all information truthfully *

Yes

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