Assignment Extension Form

Faculty of Education and Arts

ONCE COMPLETED, PLEASE SAVE THIS FILE AS ASSIGNMENT
EXTENSION REQUEST Your Name & ID Number AND EMAIL IT TO
YOUR LECTURER
Name
:

ID
Number
:

Liam Dodds

Program Name: (e.g.

Bachelor of .)

30125689

Bachelor Arts (Music Theatre)

Course Code &

Title:

PADWD2003 Dance

Assignment
Name:

Jazz assessment

Reason for
requesting
Extension:

Attending funeral

Extension
requested until
(Date):

16/6/15

I acknowledge that disciplinary action may be taken if I knowingly supply

false or misleading information. I certify that, to the best of my knowledge,
the information supplied on this form is complete and correct.
Agree

Please check box as your confirmation of the above statement

Extension Granted: YES

Date for Submission

NO

Revised Final

Click here to enter text.

Comments:

(Scan and attach to the email documentary evidence: medical certificate, work already completed towards the task)

Assignment Extension Form

Faculty of Education and Arts
NOTE: This form is ONLY for use to apply for an extension in an individual course. If extension(s) are required for multiple
courses, an application must be made for Special Consideration.