Application For Extension Of Time For Submission Of Assessable Work
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1
2PERSONAL DETAILS
(Please complete using blue or black ink)
FAMILY NAME
GIVEN NAMES
CONTACT NUMBER
STUDENT NUMBER
APPLICATION
PROGRAM NAME
PROGRAM CODE
FOR EXTENSION OF
TIME FOR
SCHOOL
DATE OF BIRTH (DD/MM/YY)
SUBMISSION OF
ASSESSABLE WORK
PROGRAM TYPE:
Prep
TAFE
Undergraduate
Postgraduate
This form is to be used when applying for an extension of time of seven calendar days or less from the original due date for submission of
assignments, projects, or essays. It must be lodged no later than one working day before the original submission due date.
This form is not to be used for exams, tests, or lab-based assessments. Refer to the Special Consideration policy for these items and for
applications for extensions of greater than seven calendar days.
SECTION A:
To be completed by student
Course Code
Catalogue Number
Course Title
For example:
Introduction to Mathematics
3
M
A
T
H
1
2
4
Lecturer/Tutor
Course Coord
Tutorial group
Description of assessment
e.g. “Social Psychology essay”
Proposed due date*:
/
/
Original due date:
/
/
* Must be no greater than seven calendar days from original due date.
Please provide detailed reasons for requesting an extension supported by original documentary evidence.
Attach a separate sheet if necessary.
Applicant Declaration
I declare that the information provided by me above is true and complete. I acknowledge that the
Is supporting documentation attached?
University reserves the right to confirm the information provided.
(e.g. medical certificate)
/
/
YES
NO
Student signature
Date
SECTION B:
To be completed by School (Course/Program Coordinator)
Application outcome:
New due date:
/
/
Approved
Denied
Authorised Staff
Signature:
Date:
/
/
Name:
Sections A and B of this form are to be placed on student file by the SCHOOL.
This section to be attached to assignment/project/essay by the STUDENT.
SECTION C:
To be completed by School staff member who completed SECTION B
Student No:
Student Name:
/
/
Course Code
Catalogue Number
Description of Assessment Task
Original due date:
Application outcome:
Approved
Denied
New due date:
/
/
Authorised Staff
Date:
/
/
Name:
Signature:
Owner: Student Administration
Extension of Time for Submission of Assessable Work Application Form
January 2008
Page 1 of 2
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