Assessment Submission Extension Form

(Provide CORRECT unit code and name in BLOCK LETTERS)

Reason for Extension
You must attach SUPPORTING DOCUMENT (e.g., medical certificate, letter from a health counsellor).

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• I declare that to the best of my knowledge, the information supplied by me is true, correct and complete in every respect.
• I am aware that if I extend the duration of my assessment submission I may need to extend my eCoE, and in the event that my visa expires prior to the completion of the course, I will be required to apply for a new student visa to complete the study.
Your Signature
Date

DayMonthYear
-------------------------- LEAD college to Complete ------------------------
Trainer / Assessor Name
Extension Granted
New date for completion or submission of assessment

DayMonthYear
Confirm that student has been informed of extension and new date for assessment
Confirm amendments made to unit end date for this student if applicable (liaise with admin team)
Confirm that the original of this extension request is stored with the Assessment Record Book/ Student file
Trainer/Assessor Signature: ___________________ Date:______________
Should be Empty: