Special consideration application form TA493 / TA930

Special consideration application form TA493 / TA930

Exceptional circumstances/Alternative assessment arrangements
Form No: TA493 / TA930
Last Revised: January 2025
Version: v8
Before submitting an application for special consideration on the grounds of exceptional circumstances or alternative assessment arrangements, applicants should ensure they have read and are familiar with the provisions of the ACEM Exceptional Circumstances and Special Consideration Policy (the Policy) and/or the Exceptional Circumstances and Special Consideration Policy: Examinations. Applications must be submitted within the timeframe(s) stipulated in the policy.
1. Applicant details
Applicant name*

First NameLast Name
ACEM ID*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number*

Area CodePhone Number
Email *
(Communication will usually be via email)
If it is not possible, due to the nature of the event(s) in question, for the individual requesting special consideration to submit the application, it may be submitted by the individual’s nominee.
Nominee name (If applicable)

First NameLast Name
Phone number

Area CodePhone Number

Declaration
In submitting this form:
- I confirm that I have read the ACEM Exceptional Circumstances and Special Consideration Policy and/or Exceptional Circumstances and Special Consideration Policy – Examinations and agreed to abide by the terms and processes set out therein;
- I have provided all information relevant to my application with this form and acknowledge that failure to provide any and all relevant information my affect the outcome of my application; and
- I understand that my application will not be progressed until the applicable fee, if any, has been paid.
Signature of applicant*

Clear
Date*

1. Applicant details