Assignment Extension Request Form

Please complete all sections of this Assignment Extension Request application form and submit it along with
supporting documentation to ICHAS no later than 5 days prior to the assignment submission date. There is a
minimum turn-around time of 24 hours for processing extension applications. Please refer to the QA manual
https://ichas.ie/wp-content/uploads/2021/05/Procedures-associated-with-Personal-Extenuating-
or-Mitigating-Circumstances.pdf
regarding the grounds on which extensions may be granted. The duration of an extension will not exceed 7 days.
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Contact Details:

Student I.D. Number: ________________________________________

Student Name: ________________________________________

Email: ________________________________________

Mobile Phone No.: ________________________________________

Details of Assignment:

Year of Study: ________________________________________

Module Title: ________________________________________

Module Lecturer: ________________________________________

Assignment Due Date: ________________________________________

Reason for request: ________________________________________

________________________________________

________________________________________

Period of Time Requested: ________________________________________

Supporting Documentation: ________________________________________

________________________________________

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By submitting this application, you declare that ALL of the information provided is TRUE and
CORRECT

Student Signature: ___________________________ Date: _____/_____/______