Missed Assessment Application Form printable pdf download

Missed Assessment Application Form

Missed Assessment

Application Form

Fill in the top section, attach appropriate letters or certificates and hand in to SEA, LSC or your teacher.

Name:

Rōpū Class:

Date of application:

Missed assessment details:

Subject:

Name of teacher:

Standard number and title:

Type of assessment activity (test, practical, assignment etc)

Date of assessment or due date:

Reason for missing assessment: (please tick one)

Illness: attach a note from a registered Health Professional

q

Family/personal trauma: documentation must be attached (e.g. letter from parent,

q

counselor or tutor group teacher/dean)

School sporting/cultural activity: ______________________________

q

Signature of teacher-in-charge of activity: ________________________

Decision by HOF/Deputy Principal:

Extension granted. New due date: ________________

q

New assessment date granted. New date: ______________

q

Existing evidence of student achievement will be used in determining a grade. (HOF

q

to attach documentation of evidence used and grade awarded)

Application denied. Comment:______________________________________

q

The reason for this decision has been explained to me and I accept the decision.

Signed: ___________________________ (student)

Signed:_________________________________

Date:________________

(HoF, P.N. or D.P.)

Missed Assessment Application Form