[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 145

10623 Berlin]

Berlin, [date]

Application for academic adjutsment for disabled and chronically ill students pursuant to Sections 4 (7), 9 (2), 31 (3) BerlHG and Sections 39 (9) and 40 (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:

• […]

Examples:

• 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].

Sincerely,

[Student first and last name and signature]

Attachment: Medical certificate or statement of a psychotherapeutic professional
[and copy of disability ID if available]