[Student first name Last name]
[Street and house number]
[Zip code and city/town]
Matriculation number […]
An den Prüfungsausschuss des Studiengangs […
z.Hd. des*der Prüfungsausschussvorsitzenden [Frau/Herr …]
[Straße des 17. Juni 135
Application for academic adjustment for students with disabilities and/or chronic illnesses pursuant to Sections 4 (7), 9 (2), 31 (3) BerlHG and Sections 39 (9) and 67 (1) AllgStuPO
Dear [Name of the chair of the examination board],
Due to my illness/disability, I have the following symptom(s) […]. This leads to difficulties in the following areas [description of your impairment(s) and their impact].
Because of my illness/disability, I am unable to complete coursework and examinations in the required form.
I thus request compensation for disadvantages in the form of:
- Flexible submission deadlines for [e.g. homework, term papers, portfolio examinations]
- […] % more time for written exams
- A separate examination room which can be shared by a few other participants
- When needed, up to [...] breaks of up to [...] minutes during oral [and/or] written exams
- Modified contribution to group work during periods of severe restriction, e.g. serving as a “plus one” to the group, possibility to complete work independently
- Attendance regulations
In order to be able to study properly, I request academic adjustment for [the semester(s), the module(s) or for my entire bachelor’s/master’s studies].
[Student first and last name and signature]
Attachment: Medical certificate or statement of a psychotherapeutic
[and copy of disability ID if available]