FORM: STD09.015 RE-ASSESSMENT FORM

RE-ASSESSMENT FORM

Please note that there is no refund provided for re-assessment fees.
RE-ASSESSMENT FEE

Leadership and Management (per unit)
- $200
Childcare/Ageing Support (per subject/cluster)
- $300 for theory-based
- $500 for practice/workplace-based
STUDENT DETAILS:
Name*

First NameFamily Name
Student ID*
Phone Number*
Please enter a valid phone number.
Address*
Email Address*
example@example.com
Course Name*
Provide the highlight the unit for reassessment:

	Unit Code	Unit/Subject Name
1.
2.
3.

Unit Selection 1*
Unit Selection 2
Unit Selection 3
Unit Selection 4
Unit Selection 5
Unit Selection 6
Unit Selection 7
Unit Selection 8
Unit Selection 9
Student Signature*

Clear
Date*

DayMonthYear
Date
Re-assessment approved by course coordinator

ApprovedNot Approved

Type a question

	Assessor Name	Assessment Date
1.
2.
3.

Course Coordinator Signature

Clear
Date

DayMonthYear
Date
TO BE COMPLETED BY FINANCE:
Payment approved by finance officer:

ApprovedNot Approved
Reassessment fee paid
Number of unit/s
Total payment received:
Finance office signature:

Clear
Date

DayMonthYear
Date

Type a question

	Assessment Date	Unit Code	Result	Comments
1.
2.
3.

Assessor Signature

Clear
Date

DayMonthYear
Date
The copy of this form must be kept in the student file for future reference.
FORM: STD09.015 Re-assessment Form
AST UPDATED: Apr 2019, Version No.2
Should be Empty: