FORM: STD09.015 Re -assessment Request Form Version No. 4

RE-ASSESSMENT REQUEST FORM
This form must be completed by students who have submitted their assessment by the due date and the outcome was NS or NYC. Please submit the completed form to the Course Coordinator. A non-refundable re-assessment fee of $200 is payable if the re-assessment is submitted after the free submission period. Re-assessment results are made available 10 working days after the submission being received. If students require fast processing, a $50 per subject fee is payable. Please refer to the Re-assessment Policy for full details.
STUDENT DETAILS:
Name *

First Name Last Name
Student ID *
Contact Number *

Area Code Phone Number
Email *
example@example.com
Date *

Day Month Year
Date

Re-Assessment Details *

STUDENT DECLARATION:
I have read the Re-assessment policy and understand it. I am aware of the academic and financial consequences of the above request and have sought appropriate advice on these matters. I understand and agree to be bound by the Institution’s policies and deadlines. I declare that the information I have given on this application is correct and understand that by knowingly making false or misleading statements that I may be liable for prosecution. I also authorise the Wells International College to gather and obtain any necessary information pertaining to this application.
Student Signature *

Clear
Date *

Day Month Year
Date
FORM: STD09.015 Re -assessment Request Form LAST UPDATED: Aug 2018 , Version No.4
Should be Empty:

RE-ASSESSMENT REQUEST FORM