Higher Education Application For Extension/Deferred Assessment

QD510107

IMPORTANT: Please read the following information before completing this form.

Applications must be made 7 days prior to the assessment due date unless there are special circumstances that will prevent this.

In order to receive approval for anExtension/Deferred Assessment (i.e. approval to complete an assessment task or sit an examination at a later date), your application must satisfactorily demonstrate to the Unit Coordinator and Board of Examiners that the reason the assessment task was not able to be completed was due to exceptional circumstances outside your control.

Please indicate if you are applying for:

Assignment extension
Apply for an extension if special circumstances prevent you from completing your assignment or mid- semester test by the due date.
The maximum period for an extension is 10 days. If you require more than 10 days extension it will be an application for deferred assessment.
or
Deferred assessment
Apply for a deferred examination if you’re unable to sit an examination due to medical or other special circumstances.

The following are acceptable grounds for applying for an extension/deferral. They must be accompanied by documentation as required. Please indicate the basis of application:

Illness or serious health problem

Serious personal trauma

A cultural or sporting commitment at State, National or International representative level

Defense Forces Reserve commitments

Jury duty

Exceptional family, work or personal circumstances

The following are not acceptable grounds for applying for an extension/deferral:

  • Holiday arrangements including international students returning home
  • Misreading an examination timetable
  • Social and leisure events including sporting or cultural commitments not at State, National or International representative level.

An Application for anExtension/Deferred Assessment must be lodged with your Unit Coordinator BEFORE the due date of the assessment task or the date of the examination.

The only exception is where your personal circumstances (e.g. illness) have prevented this. If this is the case, you will need to provide a satisfactory explanation as to why you were unable to lodge the application before the due date and supply documentation that clearly supports your explanation within 5 working days of the due date of assessment task or examination.

You will receive a response to your application within 5 working days of the decision on your application being made.

The submission of an Application for Extension/Deferred Assessment is no guarantee that your application will be approved.

STUDENT DETAILS

Surname/Family name / Given name/s
Email address
Home phone number / Mobile number
Course title / Course code
Semester/Year / Student ID number
Are you up to date with all assessments? YES/NO / Supporting documents attached? YES/NO

Medical reasons– If an application is based on medical grounds, a student must submit Medical Certificate completed by a registered medical practitioner stating:

a)The date on which the medical practitioner examined the student.

b)The severity and duration of the complaint, expressed as a medical opinion (Certificates merely reporting the student’s account of an illness may not be accepted.)

c)The practitioner's opinion that the student was unable to sit the exam on the scheduled date of the examination.

Non-medical reasons- Applications based on non-medical grounds must be accompanied by documentary evidence supporting the case plus a signed statutory declaration attesting to the unexpected and exceptional circumstances beyond the student’s control that precluded them from sitting part or all of the relevant examination.

Requests for assignment extensions may be approved by the Unit Lecturer. Requests for deferring assessments/examinations must be submitted to Higher Education Student Services for approval by the Board of Examiners.

Examination/Assignment Details
List the examinations/assignments you are applying to extend/defer.

Unit Code / Unit Title / Lecturer / Deferring assignment? / Approved by Lecturer / Deferring examination? / Approved by Director
To be completed by Lecturer
Extension approved by Lecturer / Yes / No
Approved with or without penalty / Penalty / No penalty
Penalty % per day overdue to be applied / %

STATEMENT BY STUDENT:

I hereby apply for an Assignment Extension/Deferred Assessment in the above unit(s) as I am not able to complete the assessment requirements due to circumstances outside of my control.

The grounds for my claim are set out on in an attached statement and all supporting certificates and other documentation are attached.

I accept that I must be available to sit any approved deferred examinations during the Deferred/ Supplementary examination period as specified on the Academic Calendar.

I authorise South Metropolitan TAFE West staff, where applicable to confirm the medical certificate provided with the issuing Medical Practitioner.

I understand that I will be notified of the outcome for assignment extensions via email from my lecturer.

I understand I will be notified of the outcome for deferred examinations and the subsequent examination date via email.

PLEASE STATE THE GROUNDS FOR YOUR APPLICATION IN THE SPACE PROVIDED.

I certify that all the details provided on this form and attached are correct and complete. I acknowledge that disciplinary action may be taken if I knowingly supply false or misleading information.

STUDENT SIGNATURE / DATE

OFFICE USE ONLY

Extension / Deferred
Are the circumstances exceptional?
Medical certificate attached?
Medical certificate verified?
Statutory declaration attached?
Approved by Director (please print name):
Approval Signature:
Date:
Received by / Date
Processed by / Date
Student advised of outcome / Date
DL/CC advised of outcome / Date

RTO Provider No. 52787 TAFE International WA Provider No. 52395 – CRICOS Code 00020G

Issue date: 23/06/2017Review date: 23/06/2018Use with: QD51

Uncontrolled when printed. The current version of this document is available on QMS