EmailMe Form - Special Consideration Submission Form

Special Consideration Submission Form

Use this form to submit your special consideration application and supporting evidence.

Please read the information on this page prior to filling out this form:

LINK TO SPECIAL CONSIDERATION INFORMATION PAGE

It is important you know these facts before applying for special consideration:

1. Applications must be lodge on or before the assessment due date.
2. Special consideration can be granted once per assessment.
3. An application must clearly demonstrate that it meets the eligibility criteria as identified in this policy.
4. All applications must be submitted with supporting documents.
5. Incomplete applications will be declined.
6. You will be advised of the decision in writing via email within two (2) business days of the application date.
A. STUDENT DETAILS
Student Full Name *
Email *
Student ID IKO******* *
Campus *
B. ASSESSMENT DETAILS
Course Title *
Subject Name *
Assessment Number and Name *
Assessment Type *
Assessment Due Date: *
MM / DD / YYYY
Exam Only
Did you complete the exam?
Yes
No
Only answer if your application is regarding an exam
Did you submit any work on the set due date?
Yes
No
All other Assessent Tasks
Have you started the assessment? Is your work in progress?
Yes
No
All other assessments
Have you previously been granted an extension for this assessment?
Yes
No
All other assessments
C. REASONS AND EVIDENCE
Please select your preferred outcome of this application: *
GROUNDS FOR APPLICATION

Please select from below:
. *
Religious or cultural obligations and events
Serious illness, injury or misadventure
Serious medical condition
Serious illness or injury of an immediate family or household member
Critical incident
Bereavement of a partner, close family member, or household memberents
Unexpected carer responsibilities
Crisis or trauma such as an accident, crime or being a witness to these experiences
Major political unrest or natural disaster that requires immediate travel
Military service or jury service
Severe disruption to domestic arrangements or homelessness
Personal hardship such severe disruption to domestic arrangements, employment, or finances
Participation in sporting events at state, national or international level with an official sporting body
Other
How long have your studies been affected? *
APPLICATION STATEMENT

Please provide a detailed statement outlining the grounds for your application must be provided below.

Your statement should explain the impact of the extenuating circumstances on your ability to study and complete the set assessment task on or by the set due date.

Where an application is being made outside three calendar days of the assessment due date, your statement must include explanation for the delay in lodgment. *
Are you able to implement strategies to improve the situation? *
D. SUPPORTING EVIDENCE

All applications for special consideration must be submitted with supporting documents.

Examples of acceptable evidence include:

• Medical certificate or letter from a medical professional (who is not a family member)

• Letter of support from a counsellor, lawyer or psychologist (who is not a family member)

• Letter from an employer on an official company letterhead

• Letter from a minister of religion (or the like) or cultural authority on an official letterhead or reference to a religious or cultural calendar

• Death certificate, death notice or funeral pamphlet or certificate from a funeral director

• Police report or event number

• Letter from the Department of Defence, Justice or Emergency Services (or appropriate body)

• Jury notice letter from relevant authority or court summons

• Selection confirmation or letter from relevant body confirming sporting commitments

• Statutory declaration from people relevant to the circumstances

If you do not attached verifiable supporting evidence, your application will be declined.

Please upload your documents here: *

Add File
Evidence provided. Please select one of the following options (or other): *
Medical Certificate
Police Report
Letter of Offer
Statutory Decleration
Letter Indicating Reasons for Cancellation
Other
E. STUDENT DECLARATION

In signing below, I acknowledge, confirm and accept:

I have read the Assessment Policy and understand the process for the application and assessment of special consideration requests.

All information provided in this application is true and correct. I consent and give Ikon permission to contact medical practitioners or other relevant parties to verify the authenticity of my claims and supporting documentation and to seek further information about the originating source to make an informed decision about this application. I understand that I may be asked to provide a more specific consent to disclosure of information should this be required by Ikon.

It is my responsibility to establish sufficient grounds for special consideration and to provide the evidence to support my claims. I understand application does not guarantee the request will be granted and that it is decided on the basis of my application and the evidence supplied.

Ikon reserves the right to vary or reverse any decision in relation to this application on the basis of incorrect or incomplete information. I acknowledge that disciplinary action may be taken if I knowingly supply false or misleading information.
Student signature *
Clear
Application submission date (student to complete): *
MM / DD / YYYY