Course Extension Request Form
This form is to be used by Domestic students ONLY
Student Details
Full Name
*
Given Name(s)
Surname
Student ID Number
e.g. D000123
Date of Birth
*
/
Day
/
Month
Year
DD/MM/YYYY
Phone Number
Email
example@example.com
Course Details
Please select your course:
*
Please Select
10904NAT Diploma of Social Media Marketing
BSB30220 Certificate III in Entrepreneurship and New Business
BSB40320 Certificate IV in Entrepreneurship and New Business
BSB30120 Certificate III in Business
BSB30120 Certificate III in Business (Customer Engagement)
BSB30120 Certificate III in Business (Medical Administration)
BSB30120 Certificate III in Business (Administration)
BSB40215 Certificate IV in Business
BSB40820 Certificate IV in Marketing and Communication
BSB50120 Diploma of Business
BSB50120 Diploma of Business (Business Development)
BSB50120 Diploma of Business (Leadership)
BSB50120 Diploma of Business (Organisational Development)
BSB50120 Diploma of Business (Operations)
BSB50820 Diploma of Project Management
BSB50420 Diploma of Leadership and Management
BSB60420 Advanced Diploma of Leadership and Management
If you are enrolled in a DUAL qualification, please select the first course in the enrolment
Course Start Date
*
/
Day
/
Month
Year
Course End Date
*
/
Day
/
Month
Year
Please explain why you were not able to complete your course within the expected timeframe:
*
Requested duration of extension:
*
How long do you need to complete the remaining coursework?
*
Weeks
Months
Please upload any evidence to support your extension request:
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Your Signature:
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Submission Date:
*
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Day
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Month
Year
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