Dean’s Extension Application Form

The Dean’s Extension Application Form is to be used only when requiring an extension of up to 28 days or beyond the final day of the examination period for the semester. For extensions of up to 14 days beyond the due date and no later than the final day of the examination period, please use the Lecturer’s Extension Application Form.

Please refer to the Extensions and Special Consideration Policy available on the website,

Section A: To be completed by the student

Student Name: / Student Number
Unit Code/Unit Name
Lecturer’s Name
Assignment Topic / Original due date:
Number of days for extension / New due date:
Please provide reason/s for requesting extension supported by original documentary evidence.
Attach a separate sheet if necessary.
Documentary evidence attached ( e.g. medical certificate) ☐
Declaration:
I declare that the information provided above is true and complete to the best of my knowledge. I also understand that Pilgrim Theological College reserves the right to confirm the information provided.
Student name and signature / Date:
If submitting electronically, please type your name.

Section B. To be completed by the Dean/ Coursework Coordinator

Application Outcome: / Approved ☐ / Denied ☐ / New due date
College Dean/ Coursework Coordinator:
Name and signature / Date

Submission instruction:

Submit the completed form directly to the College Dean or the Coursework Coordinator at least 5 working days before the due date for the assignment.

Response will be forwarded by the College Dean / Coursework Coordinator to the applicant, Registrar and to the Unit Lecturer.

Pilgrim Theological College will advise the outcome of the application within 3 days. If a response is not received after 3 working days, please contact the Registrar’s Office at 03 9340 8892.

The work must be submitted not later than the newly agreed due date.

A student has the right to appeal against the reduction of a grade for late work in accordance with the Appeals Policy,

R:\Pilgrim Theological College\Registrar\Forms\Dean's Extension Application Form.docx_29/04/2015

29 College Crescent Parkville Victoria 3052 Australia

Telephone +61 3 9340 8800 1800 632 960 Facsimile +61 3 9340 8805