Statement of hindrance request

Privacy

The university will handle your request strictly in accordance with the privacy regulations (GDPR). Your data will only be seen by staff of the Student Support Services.
Begin typing to search for your study programme or choose from the drop-down menu.


When did this situation occur? You can state more than one period (maximum 4)
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Before you submit this form, please read through the following carefully:

  • An expert statement must always include the following information: 
    • First and last name.
    • Date of birth.
    • Relevant information (i.e. no assessment) regarding the (medical) circumstances/diagnosis.
  • An expert statement must be issued by a doctor or a BIG-registered practitioner.
    If you don’t have a statement, you can ask your doctor for a copy of your medical records. You are always entitled to them. 
    • Medical records | Government of the Netherlands
    • About the BIG-register | Government of the Netherlands
  • Provide only the (medical) information necessary for your application; you may black out any irrelevant parts.
  • In other circumstances: in addition to completing and submitting this form, make an appointment with one of the student counsellors.
    • Make an appointment | see the ‘student counsellors’ section on the right-hand side of the page.
  • If the “special family circumstances” relate to a death, please attach a photo or copy of the funeral card along with your application.
  • If you have any questions, please feel free to email hinder@sea.leidenuniv.nl.

 
* = Input is required
 
The form cannot be opened. This form requires files to be attached. Unfortunately, the system that you use (Safari on iOS) does not support this.
Only the digits of your student number.
If your programme is not in this list, please select 'Programme not listed' at the bottom of the selection panel and declare the correct programme below, at the top of your description of your situation/cirmumstances.
 You can select more than one.
You can upload max. 3 attachments. If you need to include more, please send these additional documents to: hinder@sea.leidenuniv.nl