Special Consideration Application Form

(Please complete and submit this form to Student Services at your Campus)

Students who are unfit to attempt, or submit, an assessment by the due date
as a result of acute illness or other exceptional circumstances beyond their
control, may apply for special consideration. Causes for the application of
special consideration. Causes for the application of special consideration
include acute illness, loss or bereavement and hardship/trauma.

STUDENT DETAILS (To be completed by the student)

Campus: Brisbane Gold Coast Melbourne Sydney

Student Name: Student

Ritisha ID: Mee3042

Current Course: Trimester/Year:

MBA 2022

SPECIAL CONSIDERATION APPLICATION DETAILS

Unit Code Assessment Type Assessment due date

(e.g. test, exam, assignment) (dd/mm/yyyy)

Hi6025 Online Test 21/04/2022

Reason for application of special consideration (choose one option below):

Acute illness (medical practitioner must complete report on next page)

Loss or bereavement (attach documentation)

Hardship / trauma (attach documentation)

Other – please specify in the table below (attach documentation)

I was trying to attempt my online test on April 21, 2022. My laptop hanged and my internet got
disconnected. When I refreshed the tab, I was not able to start the test again and it was saying
that it is already opened in another tab. I immediately emailed my course instructor and the
technical team of the Holmes. I'm also attaching the screenshots as a proof. You can see that
still I have 50+ minutes of my remaining time left when I incurred this issue.
Please allow me to retake my test so that I can perform better in this course. I would be very
Holmes Institute/Holmes
thankful Colleges
to you.
185 Spring Street, Melbourne, Victoria 3000, Australia
Telephone: +61 3 9662 2055 Website: www.holmes.edu.au CRICOS Provider Codes: Holmes Institute Pty Ltd VIC 02639M; NSW 02767C; QLD 02727M
MEDICAL PRACTITIONER / HEALTH CARE PROVIDER SECTION
(To be completed by a registered medical practitioner or health care provider only)

Nature of condition: Please provide a brief, specific description of the student’s medical
condition and how it will impact the student’s ability to undertake a class test or
examination/s.

Duration of above condition: Date from: to:

(***If this medical certificate certifies a period of illness prior to the issued date, please carefully explain the
discrepancy, when appropriate. This is to ensure that an accurate assessment of the student’s situation can be made)

Practitioner’s Name: Practitioner’s Stamp

Practitioner’s Provider or Registration Number:
Practitioner’s Phone Number:
Practitioner’s Signature:
Date:

STUDENT DECLARATION
I declare that all information given is true and complete. I acknowledge that Holmes Institute
reserves the right to confirm the information provided and may vary or reverse any decision
regarding special consideration on the basis of incorrect / incomplete information.

I understand that:

• For tests or examinations, the form must be submitted within THREE (3) working days
following the date of the test or examination. For any other assessment, the form must be
submitted prior to the assessment due date.
• The outcome of this applicatoin will be sent to my Holmes Webmail Account.
• Submission of the special consideration form does NOT guarantee that special consideration
will be granted.

Student Signature: Date: 22/04/2022

OFFICE USE ONLY

Special Consideration Application Outcome: Approved Not approved

Reasons for approval or rejection of this application:

Staff Signature: Date:

Holmes Institute/Holmes Colleges

185 Spring Street, Melbourne, Victoria 3000, Australia
Telephone: +61 3 9662 2055 Website: www.holmes.edu.au CRICOS Provider Codes: Holmes Institute Pty Ltd VIC 02639M; NSW 02767C; QLD 02727M