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Extension Request Form
A student may apply for an extension of the due date for an assessment task if extenuating circumstances outside their control, and sufficiently grave in nature or duration, cause significant disruption to their capacity to study effectively. To apply, complete this form and submit it, with supporting documentation, to the Head of Secondary Schooling. This form must be lodged no later than 3 working days prior to the due date of the assessment task.
Family Name
*
Given Name
*
Year Level
Choose your year level
Year 10
Year 11
Year 12
I would like to request an extension of time to complete the following assessment task
Subject
*
Title of Assessment Task
Teacher’s Name
*
Due Date
*
DD
/
MM
/
YYYY
Amended due date requested by student
*
DD
/
MM
/
YYYY
When do you complete sports training?
Monday afternoon
Wednesday Afternoon
Do you currently complete examinations in Continuous Learning?
Yes
No
Evidence must be provided demonstrating the severity and/or gravity of the event and that it has disrupted previously satisfactory work during the session of enrolment.
*
Please select
Serious illness. Medical Certificate must be completed by your medical or Dental practitioner.
Death or serious illness of immediate family member. [Letter from parent required]
Selection to represent at International, National or State level in a sporting or cultural event.
Crisis / Trauma. [Letter from parent required]
Other [Detailed information in text box below]
If you chose 'Other', please explain your reasons here. You can still upload documentation.
File Upload
File Upload
File Upload
STUDENT DECLARATION
*
Please select
I declare that the information provided by me on this form is true and correct.
Today's Date
*
MM
/
DD
/
YYYY
