Extension Form – Southern Cross Institute

Assessment Extension Form

Personal Details

Student ID(Required)

First Name

Last Name

Telephone Number

Email Address(Required)

Please use your College outlook email address.

Current Address

Course

Major

Instructions

For your Assessment Extension application to be assessed you must:

Complete all fields in the sections below;
Attach a personal statement outlining the reason for you request;
Supply supporting documentary evidence
Submit these documents to Student Support Officer in person at the SCI Campus - Level 2, 1-3 Fitzwilliam Street, PARRAMATTA NSW 2150 Australia;
Additional information to assist you in completing this information can be found on Page 3 of this form.

Assessment(s) for which you are seeking extension

Unit code and Name(Required)

Assessment Number(Required)

Name of the Lecturer(Required)

Group Assessment or Individual Assessment(Required)

Please indicate the Group Name and Members. Example: "Group 1, SCIXXX1, SCIXXX2, SCIXXX3 ".

Assessment Submission Date(Required)

Did/will you submit your assessment on the scheduled date?

Yes

Extension reason (Please write the reasons here)(Required)

Supporting File

Drop files here or

Max. file size: 800 MB.

Student Declaration

I understand the requirement for this application and will submit:(Required)

This application form;

My personal statement;

Supporting documentary evidence.

I declare that the information provided in this Application Form is accurate. I have read and understand the information about the Special Consideration given below in this Form. I agree and give my consent to SCI to release my personal information for the purpose of this application.