APPLICATION FOR EXEMPTION

EXEMPTIONS should be lodged the day after returning to school.

An EXEMPTION means that you will not receive ZERO for a missed assessment.

SECTION 1: To be filled in by the student:

First Name: …………………………… Surname: …….………………….YEAR: ………HRM: ………

Subject: ………………………………… Teacher's Name: …..……………….…………………….

Late submission/performance (enter original dates):

Date set: ........../........../.......... Date due: ........../........../..........

Reason for request for EXEMPTION: eg sick, bereavement

………………………………………………………………………………………………………………………………………………………………………………

SECTION 2: To be filled in by the student’s Parent/Guardian:

I acknowledge and support this application. Please grant the request for the following reasons:
………………………………………………………………………………………………………………………………………………………………………………

Please attach any medical certificate or other supporting documentation.

Signature of Parent/Guardian: ……………….……… Date: ........../........../..........

SECTION 3: To be filled in by the Subject Teacher:

Missed in-class assessment:

Type of assessment: test/quiz/essay/talk/other: ……………………

Date of assessment: ........../........../..........

Other relevant information:

………………………………………………………………………………………………………………………………………………………………………………

Exemption granted. Exemption not granted.

Signature of Teacher: ………………………………………….……. Date: ........../........../..........

Referral to the HEAD OF LEARNING AREA and/or DEPUTY PRINCIPAL (in charge) if required.

Comments:

………………………………………………………………………………………………………………………………………………………………………………

Teachers please make 3 copies and forward to relevant staff.

r COPY to Subject Teacher r COPY to Head of House r COPY to Head of Learning r ORIGINAL to the STUDENT FILE.