ACFE Assessment Submission Extension Form

The application must be submitted THREE DAYS before the deadline. Be aware that non submitted/unapproved application will not be considered as valid. $250 will be charged for delaying assessments submission without being approved by ACFE-Australian Centre of Further Education. Please fill up all the mandatory fields below

Name *

Prefix First Name Middle Name Last Name

Gender *

Male Female Prefer not to say

Student ID *

Current Course/s Name: *

Phone Number *

Email Validator *

(Provide CORRECT unit code and name in BLOCK LETTERS) *

Unit Code

Unit Name

Assessment name / Number

Assessment due date

Trainer’s name

1

2

3

4

5

Description of Circumstances

Please tick all relevant boxes where they are applicable and clearly state the circumstances that have an impact on your studies. You must state the affected duration (in days, weeks or months). *

Medical condition (Please attach medical certificate) Death or serious illness of immediate family member (Please attach a letter from a counsellor, doctor or health practitioner indicating the condition. Please provide the proof of the relationship between family member and the student) Crisis/trauma (Supporting evidence may include a medical certificate or other documents from counsellor, doctor, or police depending on the nature of the issue. The evidence must demonstrate the severity and/or gravity of the circumstance which can impact the student’s studies). Mandatory commitments (The student has unavoidable commitments such as jury duty, court appearance, military reserve activities and, emergency service commitments. Please attach documentation showing compulsory appearance dates).

You must attach SUPPORTING DOCUMENT (e.g., medical certificate, letter from a health counsellor, email attachment from your trainer or course coordinator etc ). *

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Please provide your current contact infomation.

Address *

Street Address

Street Address Line 2

City State / Province

Post Code Country

• 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.

Full Name *

Your Signature *

Clear

Date *

Date

Assessment Submission Extension Form | V2 - Revised December 2020

ABN: 37 135 002 167