Community Services

Student Request for Extension of Assessment/Assignment

(Please submit this form before the original due date)

1. It is required that all students submit their work by the DUE DATE.
2. Extensions longer than one week require a Medical Certificate.
3. There is a MAXIMUM extension of 2 weeks from original due date unless authorized by the
Education Manager of Student Services.
Student/Class Details
Student Name & ID Date:
Course Code & Title
Unit Code & Title
Teacher Name

Assessment for which the extension is sought

Assessment

Due date:

Student Signature:
Reason for Extension Request

Doctor’s Certificate Provided

Yes Please attach if relevant No

Teaching Staff (Approval or Decline)

No Yes Approved Revised Due Date:

Comment:

Teachers Name & Signature:

Name Signature Date

For Extension Applications for More than 2 Weeks
Education Manager or Student Services Name & Signature:

Name Signature Date

H:\Admin\Forms\2020\Dept Course Forms\2020 Student Request for Extension - CS v2.1.doc