CSC263H:  REQUEST FOR SPECIAL CONSIDERATION
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  Student number: ______________________     Lecture Section: ___________________


  Last name:      ______________________     Instructor:      ___________________


  First name:     ______________________     Name of TA:      ___________________


  Email address:  ______________________     Date of request: ___________________


  Assignment/Test number: ______________    


 Reasons for request (be concise and clear, use the reverse if needed; submit
 supporting documentation together with this form, directly to your instructor):