Application For Assignment Extension: Reason
Application For Assignment Extension: Reason
Student Name:
Student Number:
Contact Details:
Unit Name:
Unit Code:
Lecturers Name:
Assessment Title
Semester:
Year:
Reason: (See overleaf for Notes relevant to the completion of this Application related to evidence to support your reason)
Medical Condition (Refer to the student medical certificate@ accompanying this document)
Other (Supporting documentation attached or provided separately)
Details of Other reasons:
I certify that the information contained in this application is true and correct.
Student Signature:
(Select if lodging electronically
Date:
or sign)..
*By submitting this assignment and cover sheet electronically, in whatever form you are deemed to have made the declaration set out above
Date Received:
D..../M..../Y.....
Date Sent to Lecturer:
D..../M..../Y.....
CDU Staff do not wish to pry into the personal affairs of students however in interests of ensuring the principles of equity and
fairness, appropriate evidence (preferably documentary) to support the application will be required. If students are concerned about
their privacy in these situations, they should seek assistance from appropriate, unrelated, responsible persons to provide
verification of their circumstances. The University provides confidential access to University Counsellors who are available to assist
students.
Appropriate documentary evidence for compassionate grounds might include:
Bereavement notice
Letter from employer, professional or practitioner
Statutory declaration
Copy of accident report
Please note that University Counsellors are generally not able to provide supporting documentation for compassionate grounds
unless the student has seen them prior to requesting an extension, special assessment or special consideration.
Attendance at sporting events, holidays and other discretionary travel, other discretionary activities and/or other foreseeable events
etc. will not constitute valid events and/or circumstances outside the students control and therefore will not constitute valid reasons
for an extension, special assessment or special consideration. However situations related to the above that are outside the
students control may be considered.
Given Names
Phone : (____)
Postcode :
I,....................................................................................................................................
on
DD
The patient is suffering from a medical condition, AND the illness is considered, chronic/acute
(delete non-applicable).
In my opinion the student=s medical condition will affect the following: (please tick)
In a minor way
Moderately
Severely
LECTURES
ASSIGNMENTS
PRACTICAL SESSIONS
PRIVATE STUDY
DD
/ MM
/ YYYY
to
DD
/ MM
/ YYYY