Please note that any information and documentation supplied with this assessment form will be treated in the STRICTEST OF CONFIDENCE and will NOT be shared with any THIRD PARTY - except when required by Law
 
Any Postgraduate assessment request MUST BE supported in writing by your Head of Department.  
Please email all medical & supporting documentation & supporting correspondence from your HEAD OF DEPARTMENT to joan.oriordan@mu.ie

Please complete this form and attach all relevant supporting documentation for assessment.

Personal Details
Brief description of reason why you are requesting a Medical/Exceptional Circumstances Waiver. Please note that all medical documentation must have a clear and concise time frame of any illness stated on same.