Illness / Misadventure Application Form
This form is to be submitted by a student who suffers unexpected illness, accident or misadventure immediately prior to or during the course of a school-based assessment task or examination.
Application Date
*
/
Day
/
Month
Year
Date
Student Name
*
First Name
Last Name
Student Email Address
*
Subject Area
*
Ancient History
Biology
Business Studies
Chemistry
Commerce
Community and Family Studies
Construction (VET)
Design and Technology
Drama
Earth & Environmental Science
Economics
Engineering Studies
English
Food Technology
Geography
History
Hospitality (VET)
Industrial Technology (Multimedia)
Industrial Technology (Timber)
Information Processes Technology
Information Software Technology
Italian
Japanese
Legal Studies
Mathematics
Modern History
Music
PASS
PDHPE
Physics
Religion
Science
Society and Culture
Sport, Lifestyle and Recreation
Technology
Textiles
Visual Arts
Visual Design
Teacher's Name
*
Year Group
*
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Class Code and Name
*
This code can be found on you're Compass Timetable
Assessment Task Name and Number
*
Assessment Task Due Date
*
/
Day
/
Month
Year
Date
Reason for Application:
*
Supporting Documents Attached:
*
Yes
No
For Example: Medical Certificate or other supporting documents
Please attached supporting document here:
Choose File(s)
All common formats accepted. e.g. pdf, png, jpg, docx, xlsx etc.
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of
Parent's Name
*
First Name
Last Name
Parent's Signature
Submit request
Should be Empty: