Special Consideration Application Form

Instructions for Student

Complete all sections of the form: Ensure that all required details are filled in accurately.
Provide a clear explanation: In the "Explanation of Circumstances" section, describe how the short-term circumstances have affected your ability to complete the assessment.
Attach supporting documentation: You must provide relevant supporting evidence, such as medical certificates, police reports, or statutory declarations.
Sign the declaration: Your application will not be processed without your signature.
Submit the form within the deadline: Applications must be submitted within five working days of the missed assessment or exam, unless exceptional circumstances prevent timely submission.
Lodge your application: Submit the completed form and supporting documents to Student Services via email or in person. Forms can also be accessed on the Learning Management System.
Await confirmation: You will receive a confirmation of receipt and be notified of the decision once your application has been assessed.

Student Information

Full Name

First NameLast Name

Student ID

Email

example@example.com

Phone Number

Format: (000) 000-0000.

Course Name

Unit Code(s)

Unit Coordinator Name

Lecturer Name

Assessment Type (select all relevant)

Assessment Due Date or date of missed assessment

Date

Select Reason

Explanation of Circumstances max 500 words

Supporting Documets

Other

Attached

Declaration and Signature

I declare that the information provided is true and correct.

Student Signature

Date

Received By

Decision

Comments

Date Received

Date

Unit Coordinator Signature

Date

Authorised Staff Signature

Date

General Information