Special Circumstances Request Form Page 3
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3Section 4: Declaration:
I am aware of the academic and financial consequences of the above request and have
sought appropriate advice on these matters.
I understand that withdrawn units will appear on my academic record.
I declare that the information I have given on this application is correct and understand
that by knowingly making false or misleading statements I may be liable for prosecution.
I authorise Unilearn to gather and obtain any necessary information pertaining to this
application from the relevant provider universities.
Signature:
Date:
Next Steps
Please forward this form with supporting documentation to:
Mail:
Unilearn Administration
Learning Network Queensland
Locked Bag 3
EAGLE FARM BC QLD 4009
AUSTRALIA
Email:
Unilearn@lnq.net.au
Fax:
07 3869 8274
If you have any enquiries, please contact us on (07) 3307 4768 or through our website at
If you are dissatisfied with the decision, you may request a review from the Review Officer,
Unilearn. Unilearn collects stores and uses personal information for the purposes of enrolling
a student in a unit/s of study and managing participation in that unit/s.
The information collected is confidential and will not be disclosed to third parties without your
consent, except to meet government, legal or other regulatory authority requirements.
Contact information
Unilearn Administraton
Learning Network Queensland
Locked Bag 3
EAGLE FARM BC QLD,4009
AUSTRALIA
Ph: 07 3307 4768 Fax: 07 3869 8274
Email:
unilearn@lnq.net.au
Version
Internal
Page Number
Document Name
Application for Special Circumstances – LNQIF1037
January 2013
Unilearn
Page 3 of 3
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