Special Consideration Application

For a FINAL EXAM, this form must be submitted NO LATER THAN THREE WORKING DAYS after the exam.

For a piece of ASSESSMENT DURING SEMESTER this form must be submitted NOT LATER THAN THREE WORKING DAYS after the assessment due date.

You MUST attach documentary evidence from a third party, eg health professional or doctor, to support your application.

Student Details

Student Identification Number *

First name *

Surname *

Mobile / Phone

Email address

School *

Program name *

Campus *

Fremantle
Sydney
Broome

Special consideration requested for

Course code*	Course Title*	Assessment due date	Exam date and time	Lecturer's name
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Special consideration requested for

Description of circumstances *

Death or illness of immediate family member
Personal or family trauma or crisis
Confidential personal crisis
Other

Supporting details *

Declaration *

I declare the details I have supplied to be true and correct

Supporting documentation * Upload a max of 3 files (max 20MB total). If you need to upload more documents, consider compressing all files into a zip file for uploading.

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If you experience any problems or have any questions regarding this form, please contact Student Administration:

Fremantle
Ph: (08) 9433 0781
E: student.admin@nd.edu.au

Sydney
Ph: (02) 8204 4418
E: student.admin@nd.edu.au

The information provided in this form will only be used for the administrative or educational purposes of the University, or in accordance with your specific consent. The University will not disclose your personal information to a third party unless required to or permitted by law or where you have consented to the disclosure. Information relating to how the University collects, uses or discloses your personal information and how you may complain about the University’s handling of your personal information is contained in the University’s Privacy Policy.
You have a right to access your personal information that the University holds about you and to seek its correction. If you wish to access your personal information or inquire about the handling of your personal information, please contact Student Administration at student.admin@nd.edu.au